Electronic health records or EHRs are gaining prominence in healthcare, largely due to the current government incentives (and future dis-incentives) associated with their use. Medicare-participating practices that implement EHRs stand to earn bonuses on their Medicare billings over the next several years. With time, bonuses go away and practices will face penalties for failure to use EHRs.

Practices implementing EHRs must make a number of important decisions, starting with the selection of an EHR platform. This can be a costly proposition for a practice and represents just one of many potential expenses associated with EHRs. Other costs may include the purchase of new computer hardware, staff training, and the development of an on-line patient information portal, one of many requirements of “meaningful use.”

There are multiple criteria for achieving meaningful use, but CMS summarizes the concept in three steps:

1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
2. The use of certified EHR technology for electronic exchange of health information to improve quality of health care.
3. The use of certified EHR technology to submit clinical quality and other measures. For full information on Meaningful use visit the CMS website at https://www. cms.gov/EHRIncentivePrograms/30_Meaningful_Use. asp#BOOKMARK1

An additional important consideration for anyone investing in EHRs is the certification status of the software. Both the brand as well as the specific version of the software should be ARRA-certified. Some vendors may be certified, but only specific versions are compliant with the certification guidelines.

These overview points are meant to provide some context to the issue of EHR implementation, especially as it relates to specialties like neurology. The purported benefits of EHRs are numerous, ranging from environmental (paperless), to cost saving (for example, clinicians should have easy access to existing studies), and of course, life-saving (with better diagnoses based on more information available, less likelihood of prescribing errors, etc.), however the degree to which these benefits are actually realized remains to be seen. Furthermore, there is not a good deal of research addressing the experiences of neurologists with particular EHRs and/or their satisfaction with them.

The Survey and Findings

In order to access neurologists' experiences with EHRs, we surveyed members of the Texas Neurological Society (TNS). Prior to the February 3 – 5, 2012 TNS 15th Annual Winter Conference in Austin, an EHR satisfaction survey was mailed to the membership. A total of 416 surveys were mailed to TNS member neurologists in Texas. At the meeting, an additional 300 surveys were distributed to attendees. There was obvious overlap with some of those attending the meeting having already received the survey by mail; however, the intent was to be certain that TNS neurologists received the survey and to obtain as many responses as possible. In total, 127 neurologists filled out the TNS EHR survey.

The survey focused on comments, demographics, satisfaction, and overall use of EHR. In addition, members were queried regarding meaningful use certification. The questions were presented on a 1 - 5 Likert scale: 1. Strongly disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly agree. It was also requested that current users of electronic health records write comments about their experiences with their EHR.

The results of the TNS EHR survey are included here. (Tables 1-3) Nearly three-quarters (73.8 percent) of respondents currently used EHRs. Among those who did not currently use EHRs, 42 percent indicated that they planned to implement them during 2012.

When looking at the data, it is apparent that a majority of physicians already using electronic health records do not seem to be entirely satisfied with their system. Overall, there was no clear unanimous enthusiasm expressed for EHR. It also appears that meaningful use is still not well understood even among neurologists using EHRs.

Discussion and Implications

To date, except for the recent TNS survey, it does not appear that any recent neurology EHR surveys have been conducted. In 2007, the AAN Electronic Health Record Work Group convened at the Boston meeting where five EHR vendors were invited to participate in a presentation designed for the work group. The goals of the presentations were to provide AAN members with a report of the capabilities of each EHR system. However, several years later, neurologists are still finding it challenging to identify the proper EHR for their practice. This was exemplified in the current TNS survey. Although there have been various national EHR surveys done in other specialties, there are still no definitive studies which provide reliable estimates of the adoption or satisfaction of EHR by US physicians.

In neurology, it seems to remain difficult for the average neurologists to obtain updated peer reviewed information as to which electronic health record system may be best for their individual needs. For this reason, in the TNS survey, upon request, a number of colleagues currently using EHR have also provided their contact information for potential dialog with their fellow TNS members. Table 3 (next spread) provides an overview of respondent rankings for specific EHRs. While the number of respondents is low for each system, the responses nonetheless provide some insight for a neurologist contemplating any of these systems.

The authors have no relevant disclosures.

Randolph W. Evans, MD is Clinical Professor of Neurology at Baylor College of Medicine in Houston.

Stuart Black, MD is founding member and Medical Director of the Dallas Headache Clinic. He is Chief of Neurology and Co-Medical Director of the Neuroscience Center of Baylor University Medical Center in Dallas.