NJ Docs Are Last in EHR Use

New Jersey's office-based physicians have been the slowest in the nation to switch to electronic health records (EHRs) according to a new report from the Centers for Disease Control and Prevention (CDC.)

Electronic health records are a key component in national efforts to make health-care more efficient—and to keep tabs on what procedures and therapies physicians are using in treating patients. They also generate the big data beloved by health experts, the pharma industry, and insurers.

The CDC found there is a wide disparity in the rates at which physicians are using these electronic systems.

The state with the highest percentage (79.1%) is North Dakota. New Jersey has the lowest rate (29.2%).

Nationally, just over half (50.5%) of physicians use EHRs.

“On the face it this looks horrible,” said Joe Carr, chief information officer for the New Jersey Hospital Association, a trade group in West Windsor, NJ. “But our doctors are very different—we have a lot more physicians in small practices,” he said, where the cost of setting up EHRs is sometimes an obstacle.

“I’m actually pretty happy to see that 29 percent,” he said.

Small or solo practices remain economically feasible in NJ, due to it being densely populated, but the $100,000 to $200,000 startup cost of purchasing an EHR system could be painful.

At the Medical Society of New Jersey, chief executive Larry Downs said the majority of NJ's physicians are in small practices. "The average is 3 to 4 physicians per practice," Downs said.

It is also possible, Carr said, that the CDC data reflect only EHR systems that are federally certified as being in compliance with “meaningful use” standards. Those rules come with specific requirements that physicians may not want to bother with, Carr said. “If you’re a pediatrician, for instance, why do you want to have to ask all your patients if they smoke?” he asked. Instead, some physicians have found work-arounds, such as secured encrypted systems that can be used for a monthly fee without major investments.

Still, Carr agreed, EHRs are generally a good thing and the state has made a push to help physicians make the conversion, both with guidance and financial assistance. “We’re seeing good progress,” he said, in large part because of an initiative undertaken by New Jersey Institute of Technology, a state-run university in Newark.

Downs said many physicians are resisting because "They may find the work-flow is slower" with EHRs, and that lack of interoperability between systems. That is a particular issue for NJ where physicians may have admitting privileges at several hospitals.

According to the CDC report, in 2014 in eight states (Iowa, Minnesota, Montana, North Carolina, North Dakota, South Dakota, Utah, and Wisconsin), the percentage of adaption was higher than the national average, ranging from 64.7% in Iowa to 79.1% in North Dakota. The percentage was lower in six states, (Florida, Louisiana, Nevada, New Jersey, Tennessee, and Rhode Island), ranging from NJ’s 29.2% to 38.5% in Tennessee.

In addition to North Dakota, seven states—Iowa, Minnesota, Montana, North Carolina, South Dakota, Utah and Wisconsin have EHR adoption rates higher than the national average, and five, in addition to NJ, have lower: Florida, Louisiana, Nevada, Tennessee, and Rhode Island.

The full survey data are here.