2. 2
Monthly Attitudinal EHR Survey
● Objective: Gauge small practice physicians’ attitudes about adoption
of EHRs and evaluate trends over time
● Methodology: monthly surveys of 100 physicians
— Non-EHR users every other month (A,B,C…)
— EHR users on alternate months (1,2,3…)
— After 6 months, the initial group of respondents will be re-polled to
evaluate whether their attitudes have shifted (A2,B2,C2,12,22,32)
● Hypothesis: If physician attitudes change with the market, group A2
should test more closely to group C than to group A and so on.
Nov Dec Jan Feb Mar Apr May Jun July Aug Sep Oct Nov
A 1 B 2 C 3 A2 12 B2 22 C 2 32 A3
D* 4* E* 5*
3. 3
General Feelings about EHRs – EHRs are Good for Medicine
Note 1: Physicians who are Users have dramatically more positive feelings
towards EHR, in agreement that EHRs are Good for Medicine at an average
16% higher rate, while Non-Users are more on the fence at an average
13% higher rate. Overall feelings however remain positive.
0
50
100
150
200
250
300
350
Strongly
agree
Agree Somewhat
agree
Neither
agree nor
disagree
Disagree
slightly
Disagree Strongly
disagree
NON-USERS USERS
4. 4
General Feelings about EHRs – EHRs are Good for Medicine
115
166
93
126
20
31
38
NON-USERS
Strongly agree
Agree
Somewhat agree
Neither agree
nor disagree
Disagree slightly
Disagree
Strongly disagree
212
240
56
49
44
USERS
5. 5
Feelings about EHRs by Years in Practice Fact#2
-5
-4
-3
-2
-1
0
1
2
3
4
5
0 1 2 3 4 5
Rates Standard Deviations
-2
-1
0
1
2
3
0 1 2 3 4 5
-4
-3
-2
-1
0
1
2
3
4
0 1 2 3 4 5
New Physicians strongly believe in EHRs
Experience shows less enthusiasm, but Positive
Later career Physicians are not all convinced
40%
27% 21%
29%
Strongly Agree
0 to 10 yrs 11 to 20 yrs 21 to 30 yrs 31 to 40 yrs
11% 17% 13% 15%
Agree
0% 2% 5% 4%
Disagree
6. 6
Feelings about EHRs by Years in Practice Fact#2
0
10
20
30
40
50
60
less than
1 month
1 to 3
months
3 to 6
months
6 months
to 1 year
more
than 1
year
0 to 10 yrs 11 to 20 yrs
21 to 30 yrs 31 to 40 yrs Negative feelings in the 21 to 30
years in practice group may stem
from an inability to implement
their EHR systems within the
standard 3 to 6 months. They are
the most common group to take
more than a year to get going.
less
than 1
mon
1 to 3
mon
3 to 6
mon
6 mon
to 1
year
more
than 1
year
0 to 10 yrs 17% 31% 23% 24% 24%
11 to 20 yrs 37% 28% 19% 25% 21%
21 to 30 yrs 27% 13% 26% 29% 42%
31 to 40 yrs 19% 27% 33% 22% 13%
7. 7
Feelings about EHRs by Region Fact#5
Rates Standard Deviations
-5
-4
-3
-2
-1
0
1
2
3
4
5
0 1 2 3 4 5
-3
-2
-1
0
1
2
3
4
0 1 2 3 4 5
-4
-3
-2
-1
0
1
2
3
0 1 2 3 4 5
19%
28% 28%
36%
Strongly Agree
Midwest Northeast South West
33%
25% 29% 23%
Somewhat Agree
The West strongly believes in EHRs
8% 9% 7% 3%
Strongly Disagree
Midwest not convinced, but Positive
Pocket of Northeast with negative feelings
8. 8
Feelings about EHRs by Region Fact#5
Positive feelings for EHRs seem to
correspond to the opposite in MU.
0%
10%
20%
30%
40%
50%
60%
Definitely
will apply
Probably
will apply
Not sure Will
probably
not apply
Will
definitely
not apply
Intention to Apply for MU Incentives
Northeast West Midwest
0% 50% 100%
Very concerned
Concerned
Somewhat concerned
Not sure
Not very concerned
Not at all concerned
Concern for Govt. Penalties
Midwest Northeast West
9. 9
Feelings about EHRs by Years in Practice Fact#2
Major cities tend to act as opinion beacons;
home to strong convictions of EHR which
emanate to and affect surrounding areas.
10. 10
Feelings about EHRs by Years in Practice Fact#2
Opinions of EHR are
strongly tied to a
Physician’s experience
with the Meaningful Use
process and their ability
to implement their EHR
system quickly.
Better opinions come
with strong availability of
well thought out
educational resources
and a calculated
implementation process
with support to get them
going in under a year.
11. 11
Average Time Taken to Implement the EHR System
34%
30%
20%
10%
6%
November 2011
1 to 3 months
3 to 6 months
6 months to 1
year
less than 1
month
more than 1
year
27%
24%
25%
12%
12%
September 2010 –
October 2011
12. 12
No No No
No No
No No
No No
No
No
No
Yes Yes
Yes Yes Yes Yes
Yes
Yes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Big
City
Small
Town
Suburb Big
City
Small
Town
Suburb Big
City
Small
Town
Suburb Big
City
Small
Town
Suburb
Midwest Northeast South West
REC Awareness remains at just 11%, however RECs seem to continue their
focus on Small Towns across the board, and are most accessed by Physicians in
the Northeast, and the least in the Midwest.
Regional Extension Center Awareness
13. 13
Regional Extension Center Awareness – Most Effective RECs
State Closest Possible REC
Funding in
Millions
AL University of South Alabama $ 8
AR Arkansas Foundation For Medical Care (HITArkansas) $ 7
CA Southern California Regional Extension Center (CalHIPSO) $ 14
FL University of Central Florida $ 8
FL University of South Florida $ 6
IL Northern Illinois University, or Northwestern University $ 8
MA Massachusetts Technology Park Cooperation $ 13
MT Qualis Health, Washington – Idaho (WIREC) $ 13
NC University of North Carolina, Chapel Hill $ 14
NY New York eHealth Collaborative (NYeC) $ 27
OH Ohio Health Information Partnership $ 29
OK Oklahoma Foundation for Medical Quality, Inc. $ 5
PA Quality Insights of Pennsylvania Inc. (Eastern) $ 29
TX University of Texas Health Science Center at Houston $ 15
VA VHQC and the Center for Innovative Technology $ 12
WA OCHIN Inc. (Primary), Oregon $ 13
Awareness
Rate
3
1
2
2
2
1
1
1
2
7
1
1
4
2
1
1
14. 14
Regional Extension Center Awareness – RECs & MU
75%
80%
85%
90%
95%
100%
Will
definitely
not apply
Will
probably
not apply
Definitely
will apply
Probably
will apply
Yes
No
It is interesting to note
that ALL of the
respondents who said
they Definitely will Not
Apply for MU incentives
were not aware of any
Regional Extension
Centers.
16. 16
EHR Users – Application for MU Incentives
0%
20%
40%
60%
80%
100%
Non-Users
Definitely will
apply
Probably will
apply
Will probably
not apply
Not sure
Will definitely
not apply
0%
20%
40%
60%
80%
100%
Users
Yes, after
2012
Yes, in 2012
Yes, in 2011
Yes
No
In Users, the number of those who have Applied for incentives doubled
from 22% to 40%, while in Non-Users the number of those who Definitely
will apply fell to 2% while those that Probably will Apply rose to 60%.
17. 17
Understanding of MU and Intent to Apply
-6 -4 -2 0 2 4 6
Not Very Well
Some
Average
Somewhat Well
Very Well
Extremely Well
Understanding
Diversion from Normal Dist.
14%
4%
17%
•Most Physicians have not
completed strong research
on MU, but feel favorably
about intending to apply.
•Physicians who feel
confident in their
understanding will not
always choose to apply.
•If a Physician understands
MU somewhat, there is a
high likelihood of intent to
apply.
•A much higher rate of
Physicians are unsure of
applying if they know little,
but an unusually low
amount are unsure with
greater understanding.
Definitely Will Apply Probably Will Apply
Not Sure Definitely Not
18. 18
-8 -6 -4 -2 0 2 4 6 8 10 12
Understanding of MU and Confidence of Qualification
Understanding
7%
•Most Physicians would say
they are confident to
varying degrees of
qualifying for incentives.
•The key descriptors of
confidence seem to be ‘Very
Well’ for strong confidence
or ‘Not Very Well’ for lack of
confidence.
•Not having confidence in
qualifying definitely seems
to mimic being unsure of
their intent to apply, with a
very high incidence of being
unsure to qualify with little
understanding and a very
low rate with a greater
understanding.
Totally Confident Confident
Not at All
Not Very Well
Some
Average
Somewhat Well
Very Well
Extremely Well
Not at All
Diversion from Normal Dist.
Fairly Confident
Not SureSlightly Confident
4%
19. 19
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
less than 1 month 1 to 3 months 3 to 6 months 6 months to 1
year
more than 1 year
Totally confident Confident Fairly confident
Slightly confident Not at all confident
Confidence of Qualifying for MU and Time to Implement EHR
Confidence of qualifying for MU is strongly related to Implementation time; the faster, the more
confidence, the slower, less confidence.
20. 20
Considering a Company Obtaining MU Certification and Feeling that
EHRs are Good for Medicine
-6 -4 -2 0 2 4 6
Feeling that EHRs are Good
Strongly Disagree
Disagree
Slightly Disagree
Neither
Agree Slightly
Agree
Strongly Agree
MAYBEYES NO
40%
•61% of Physicians said
‘Yes’, they would consider
purchasing an EHR from a
reputable company in the
process of maintaining MU
certification.
•Feeling that EHRs are
Good for Medicine seems
to be strongly related to a
willingness to consider an
EHR without certification,
with 40% of Physicians
who said they would or
may consider it, also have
very positive feelings
about EHRs.Diversion from Normal Dist.
21. 21
Considering a Company Obtaining MU Certification and Intent to Apply
for MU Incentives
-6 -4 -2 0 2 4 6 8
Intent to Apply for MU
Definitely Not
Probably Not
Not Sure
Probably Will
Definitely Will
YES NOMAYBE
3%
37%
40%
Diversion from Normal Dist.
•While that 40% group of
Physicians who are willing to
consider an EHR without
certification because they
feel EHRs are good for
medicine remained constant
even when the subject of
definitely applying for MU
came up, it was balanced by
the group we would expect
to see: 37% of Physicians
were less likely to consider
an uncertified EHR the more
certain they were of applying
for MU.
•A small group would not
consider it even if they did
not plan on applying.
22. 22
Considering a Company Obtaining MU Certification and Confidence of
Meeting Requirements by MU Deadline
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Maybe No Yes
Totally confident Confident
Fairly confident Slightly confident
Not at all confident
Confidence of meeting MU
requirements seems
balanced between groups
that would and would not
chose an EHR that is not
certified. However, note that
Physicians who are Totally
Confident of qualifying for
MU incentives will not
choose an EHR without
certification at a higher rate.
23. 23
Confidence of Qualifying for MU Incentives and Topic Interest
0
5
10
15
20
25
30
35
Accountable
Care
Organizations
EHR
Implementation
Meaningful use Other Patient
Centered
Medical Home
Totally confident Confident Fairly confident Slightly confident Not at all confident
Confidence of Qualifying for MU is strongly tied to which topics Physicians are interested in:
Those who are Confident are finished with MU and have moved on to Accountable Care Organizations
or Patient Centered Medical Home. Those who are Fairly Confident want to reinforce their MU
understanding, and those who feel they have no hope are still concerned with Implementation.
Non Users Users
Users
24. 24
Understanding of MU
0%
10%
20%
30%
40%
50%
Users
DEC-2010 FEB-2011 APR-2011
JUN-2011 AUG-2011 OCT-2011
NOV-2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
Non-Users
NOV-2010 JAN-2011 MAR-2011
MAY-2011 JUL-2011 OCT-2011
NOV-2011
Understanding of MU remains in a normal distribution skewed towards some understanding for Non-
Users and average understanding for Users. However, the number of Physicians falling into these
understanding levels seems to be on the rise.
25. 25
● A lack of confidence has grown with non-users and confidence has moved from strong to fair.
● Among users, complete confidence has fallen intermittently while just confidence has risen.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Non-Users
NOV-2010 JAN-2011 MAR-2011
MAY-2011 JUL-2011 NOV-2011
OCT-2011
0%
10%
20%
30%
40%
50%
60%
Users
DEC-2010 FEB-2011 APR-2011
JUN-2011 AUG-2011 OCT-2011
NOV-2011
Confidence to Meet MU Criteria by Deadline
27. 27
Feeling EHRs are Good for Medicine and Awareness with an Affiliated
Hospital’s EHR System
0
200
400
600
800
1000
1200
1400
1600
1800
Strongly agree Somewhat agree Neither agree nor
disagree
Strongly disagree
No Yes
28. 28
Feeling that EHRs are Good for Medicine and Awareness of an
Affiliated Hospital’s EHR
-4 -3 -2 -1 0 1 2 3
Hospital Provides Programs
No Impact
Not Aware
Own Research
Feeling that EHRs are Good
Strongly Disagree
Disagree
Neither
Agree
Strongly Agree
Diversion from Normal Dist.
4%
39%
•39% of Physicians
feel pretty good about
EHR if they have an
awareness of their
Affiliated Hospital’s
EHR system, no matter
what they decide to
do with that
information.
•The largest group of
Physicians who have
strong negative
feelings of EHR also
are not aware of their
Affiliated Hospital’s
EHR system.
29. 29
Feeling that EHRs are Good for Medicine and Willingness to Choose
an Affiliated Hospital’s EHR
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Strongly agree Somewhat agree Neither agree nor
disagree
Strongly disagree
Yes
No
Furthermore, Physicians who have positive feelings of EHR are more willing to
consider their Affiliated Hospital’s EHR system. While Physicians with negative or
neutral feelings of EHR will not consider it at an average rate of 80%.
30. 30
Intent to Apply for Incentives and Consideration of Hospital’s EHR
0
10
20
30
40
50
60
70
80
90
100
No Yes
Will definitely not apply Will probably not apply
Probably will apply Definitely will apply
Will definitely not apply
Not Aware
Aware, Hospital is Providing Programs
Aware, but will not Impact Decision
Aware, but will do Own Research
53 %
increase
Physicians are much more likely to consider
their Hospital’s system if they intend to file
for MU incentives. Meanwhile, those who will
not consider it and will not apply are in fact
aware of their hospital’s system, but have
negative feelings towards it or are not at all
aware.
31. 31
Engagement with an Affiliated Hospital and Confidence of Qualifying
0
5
10
15
20
25
Totally
confident
Confident Fairly
confident
Slightly
confident
Not at all
confident
I don't / didn't know which system is used in my
hospital
I know / knew which system is used in the
hospital and the hospital is providing / provided
educational programs to help me learn
I know which system is used in the hospital but
it will / did not impact my EHR decision
I know/ knew which system is used in the
hospital and I will do / did my own research on
that system prior to purchasing an EHR0
5
10
15
20
25
Totally confidentConfidentFairly confidentSlightly confidentNot at all confident
Without knowledge or support of a
Hospital’s system, there is a high lack of
confidence.
A high rate of Physicians are confident
with and engaged hospital.
A high rate of Physicians perform
autonomous research, but are not as
strongly confident they will qualify.
Physicians who are aware but will not let
their affiliated hospital impact their
decision are surprisingly confident.
32. 32
Engagement with an Affiliated Hospital and Incentives
Hospital’s seem to be encouraging awareness and participation in programs by offering incentives for
using their system, as evinced by the corresponding rate of incentive offers to Physicians who say
they are confident in qualifying for MU and have either participated in their Hospitals Education
Program or are at least aware of their hospital’s system and incentives.
0
5
10
15
20
25
NotAware
HospitalEducation
NoImpact
OwnResearch
NotAware
HospitalEducation
NoImpact
OwnResearch
NotAware
HospitalEducation
NoImpact
OwnResearch
NotAware
HospitalEducation
NoImpact
OwnResearch
NotAware
HospitalEducation
NoImpact
OwnResearch
Totally confident Confident Fairly confident Slightly confident Not at all
confident
2 1
1
1
10
9
8
2
3
2
7
1
3 1
1
2
33. 33
Considering Hospital’s System & Understanding of MU Incentives
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
No Yes
35%
8
22
13
30
15
No
However, at some point
between having a very good
understanding of MU and
having and extremely good
understanding, Physicians
decide they can no longer
consider their hospital’s EHR
system.
34. 34
Was
24%
in Nov
83%
The Ultimate Purchase Decision
80% of those offered
an incentive from the
hospital actually
purchased the
hospital’s system vs.
26% of those with no
incentive
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
I don't know I know and I
will do my
own research
I know and
the hospital is
providing
educational
programs
I know but it
will not
impact my
EHR decision
No Yes
*No, I will not consider my Hospital’s EHR *Yes, I will consider it
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Non Users Users
No Yes
35. 35
Physicians who were offered incentives from the hospital
0%
20%
40%
60%
80%
100%
Yes
Incentives for Hospital System
No Yes
0%
20%
40%
60%
80%
100%
Yes
Incentives for Any System
No Yes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Big City Small Town Suburb
No Yes
36. 36
Considering an EHR that is Not Yet Certified
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Definitely will
apply
Probably will
apply
Not sure Will probably
not apply
Will definitely
not apply
Yes
Maybe
No
