NCHS Data Brief

Attachment I1 - NCHS Data brief

NCHS Data Brief ■ No. 261 ■ October 2016

State Variation in Electronic Sharing of Information in
Physician Offices: United States, 2015
Eric W. Jamoom, Ph.D., M.P.H., M.S., and Ninee Yang, Ph.D.

Key findings
Data from the National
Electronic Health Records
Survey
In 2015, the percentage
of physicians who had
electronically sent patient
health information ranged from
19.4% in Idaho to 56.3% in
Arizona.
●

In 2015, the percentage
of physicians who had
electronically received patient
health information ranged
from 23.6% in Louisiana
and Mississippi to 65.5% in
Wisconsin.

The Health Information Technology for Economic and Clinical Health
Act (HITECH) provides financial incentives to eligible providers using a
certified electronic health record (EHR) system (1,2). In 2015, 77.9% of
office-based physicians had a certified EHR system, up from 74.1% in 2014
(3–5). A federal plan to enhance the nation’s health information technology
infrastructure was published in 2015 to support information sharing (6,7).
Therefore, this report uses the 2015 National Electronic Health Records
Survey (NEHRS) to describe the extent to which physicians can electronically
send, receive, integrate, and search for patient health information.
Keywords: health information technology • National Electronic Health
Records Survey

●

In 2015, about one-third of physicians had electronically sent,
received, integrated, or searched for patient health information.
Figure 1. Percentage of office-based physicians who sent, received, integrated, or searched for
patient health information electronically: United States, 2015

In 2015, the percentage
of physicians who had
electronically integrated patient
health information from other
providers ranged from 18.4% in
Alaska to 49.3% in Delaware.
●

40

38.2

38.3
34.0

Percent

In 2015, the percentage
of physicians who had
electronically searched for
patient health information
ranged from 15.1% in the
District of Columbia to 61.2%
in Oregon.
●

50

31.1

30

20

8.7

10

0

Sent

Received

Integrated

Searched

NOTE: Access data table for Figure 1 at: http://www.cdc.gov/nchs/data/databriefs/db261_table.pdf#1.
SOURCE: NCHS, National Electronic Health Records Survey, 2015.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics

All

NCHS Data Brief  ■  No. 261  ■  October 2016
●

In 2015, office-based physicians had electronically sent (38.2%), received (38.3%),
integrated (31.1%), or searched (34.0%) for patient health information from other providers
(Figure 1).

●

In 2015, only 8.7% of office-based physicians had performed all four of these activities.

In 2015, 38.2% of physicians had electronically sent patient health
information to other providers.
●

In 2015, the percentage of physicians who had sent information electronically to other
providers was less than the national percentage (38.2%) in Idaho (19.4%), Connecticut
(22.7%), and New Jersey (24.3%) (Figure 2).

●

In 2015, the percentage of physicians who had sent information electronically to other
providers was greater than the national percentage in Arizona (56.3%).

●

In 2015, the percentage of physicians who had sent patient health information electronically
to other providers ranged from 19.4% in Idaho to 56.3% in Arizona.

Figure 2. Percentage of office-based physicians who sent patient health information electronically to other providers, by
state: United States, 2015

NH
39.4

WA
41.1
OR
51.4

CA
39.4

ID
19.4
NV
31.3

UT
33.5

AZ
56.3

VT
35.4

ND
37.4

MT
38.1

WY
37.4

MN
45.8

SD
42.8

IA
47.8

NE
35.8
CO
40.2

OK
34.3

TX
37.7

AK
33.2

MO
36.9

OH
45.5
KY
30.8

PA
27.1
WV
36.4

TN
39.8

AR
27.4
LA
26.5

NY
29.9

MI
49.8

IN
IL
45.2 35.1

KS
41.0

NM
35.5

WI
50.4

MS
40.6

AL
29.2

GA
31.3

VA
32.9

ME
41.4
MA
43.9

RI
39.3
NJ
24.3 CT
22.7
DE
39.9
DC
26.9
MD
38.6

NC
47.4
SC
46.5

FL
41.8
HI
41.5

Statistically significantly greater than
the national percentage
Not statistically significantly different
from the national percentage
Statistically significantly less than the
national percentage

National percentage: 38.2%

NOTES: Significance tested at p < 0.05. Access data table for Figure 2 at: http://www.cdc.gov/nchs/data/databriefs/db261_table.pdf#2.
SOURCE: NCHS, National Electronic Health Records Survey, 2015.

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NCHS Data Brief  ■  No. 261  ■  October 2016
In 2015, 38.3% of physicians had electronically received patient health
information from other providers.
●

In 2015, the percentage of physicians who had received information electronically from
other providers was less than the national percentage (38.3%) in Louisiana (23.6%),
Mississippi (23.6%), Missouri (24.2%), and Alabama (24.3%) (Figure 3).

●

In 2015, the percentage of physicians who had received information electronically from
other providers was greater than the national percentage in Massachusetts (52.9%),
Minnesota (55.0%), Oregon (59.2%), and Wisconsin (65.5%).

●

In 2015, the percentage of physicians who had received patient health information
electronically from other providers ranged from 23.6% in Louisiana and Mississippi to
65.5% in Wisconsin.

Figure 3. Percentage of office-based physicians who received patient health information from other providers
electronically: United States, 2015

NH
46.3

WA
43.4
OR
59.2

CA
37.7

ID
31.2
NV
40.7

UT
29.6

AZ
40.6

VT
36.9

ND
51.0

MT
38.0

WY
39.5

MN
55.0

SD
44.2

IA
39.5

NE
35.5
CO
47.5

OK
33.1

TX
34.9

AK
29.9

MO
24.2

OH
46.2
KY
36.1

PA
36.7
WV
37.2

TN
29.8

AR
30.8
LA
23.6

NY
29.7

MI
47.6

IN
IL
45.8 42.7

KS
42.3

NM
31.7

WI
65.5

MS
23.6

AL
24.3

GA
34.4

VA
31.5

ME
44.1
MA
52.9

RI
49.5
NJ
CT
27.1
26.8
DE
46.2
DC
32.1
MD
36.2

NC
46.3
SC
37.8

FL
37.6
HI
37.9

Statistically significantly greater than
the national percentage
Not statistically significantly different
from the national percentage
Statistically significantly less than the
national percentage

National percentage: 38.3%

NOTES: Significance tested at p < 0.05. Access data table for Figure 3 at: http://www.cdc.gov/nchs/data/databriefs/db261_table.pdf#3.
SOURCE: NCHS, National Electronic Health Records Survey, 2015.

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NCHS Data Brief  ■  No. 261  ■  October 2016
In 2015, 31.1% of physicians had electronically integrated patient health
information from other providers.
●

In 2015, the percentage of physicians who had electronically integrated information from
other providers was less than the national percentage (31.1%) in Alaska (18.4%), the District
of Columbia (18.6%), Montana (18.6%), Alabama (18.8%), and Idaho (20.6%) (Figure 4).

●

In 2015, the percentage of physicians who had electronically integrated information from
other providers was greater in Indiana (44.2%) and Delaware (49.3%) than the national
percentage.

●

In 2015, the percentage of physicians who had electronically integrated patient health
information from other providers ranged from 18.4% in Alaska to 49.3% in Delaware.

Figure 4. Percentage of office-based physicians who electronically integrated patient health information from other
providers: United States, 2015

NH
32.8

WA
31.7
OR
43.4

CA
27.6

ID
20.6
NV
33.9

UT
28.6

AZ
44.1

VT
26.1

ND
31.7

MT
18.6

WY
28.7

MN
25.3

SD
35.7

IA
29.7

NE
37.1
CO
36.2

OK
32.0

TX
23.4

AK
18.4

MO
26.3

OH
35.6

KY
32.6

PA
34.6
WV
29.0

MS
23.2

AL
18.8

VA
31.2

MA
33.9
RI
26.3
NJ
CT
22.8
24.8
DE
49.3
DC
18.6
MD
29.5

NC
39.0

TN
28.7

AR
43.8
LA
21.1

NY
31.5

MI
33.7

IN
IL
28.3 44.2

KS
28.4

NM
41.8

WI
34.7

ME
26.9

GA
28.4

SC
30.2

FL
40.0
HI
26.9

Statistically significantly greater than
the national percentage
Not statistically significantly different
from the national percentage
Statistically significantly less than the
national percentage

National percentage: 31.1%

NOTES: Significance tested at p < 0.05. Access data table for Figure 4 at: http://www.cdc.gov/nchs/data/databriefs/db261_table.pdf#4.
SOURCE: NCHS, National Electronic Health Records Survey, 2015.

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NCHS Data Brief  ■  No. 261  ■  October 2016
In 2015, 34.0% of physicians had electronically searched for patient health
information from other providers.
●

In 2015, the percentage of physicians who had electronically searched for information from
other providers was less than the national percentage (34.0%) in the District of Columbia
(15.1%), Mississippi (19.7%), Pennsylvania (20.8%), Texas (21.0%), Missouri (21.6%), and
Oklahoma (22.8%) (Figure 5).

●

In 2015, the percentage of physicians who had electronically searched for information
from other providers was greater than the national percentage in 10 states, including Ohio
(47.2%), Alaska (47.3%), Colorado (47.5%), Maryland (47.9%), Virginia (48.3%), North
Carolina (48.8%), Delaware (53.9%), Wisconsin (54.1%), Washington (58.0%), and Oregon
(61.2%).

●

In 2015, the percentage of physicians who had electronically searched for patient health
information from other providers ranged from 15.1% in the District of Columbia to 61.2%
in Oregon.

Figure 5. Percentage of office-based physicians who electronically searched for patient health information from other
providers: United States, 2015

NH
41.0
ME
VT
30.8
37.5

WA
58.0

CA
31.6

ND
41.6

MT
33.3

OR
61.2

ID
39.2
NV
36.6

UT
34.2

AZ
37.6

WY
33.4

MN
43.1

SD
42.5

IA
38.7

NE
41.0
CO
47.5

OK
22.8

TX
21.0

AK
47.3

MO
21.6

OH
47.2
KY
32.3

PA
20.8
WV
33.1

TN
31.1

AR
34.7
LA
31.2

NY
23.5

MI
44.7

IN
IL
34.8 34.7

KS
39.7

NM
31.3

WI
54.1

MS
19.7

AL
37.3

GA
25.1

VA
48.3

MA
30.3
RI
32.1
NJ
CT
32.9
35.7
DE
53.9
DC
15.1
MD
47.9

NC
48.8
SC
27.6

FL
28.0
HI
36.1

Statistically significantly greater than
the national percentage
Not statistically significantly different
from the national percentage
Statistically significantly less than the
national percentage

National percentage: 34.0%

NOTES: Significance tested at p < 0.05. Access data table for Figure 5 at: http://www.cdc.gov/nchs/data/databriefs/db261_table.pdf#5.
SOURCE: NCHS, National Electronic Health Records Survey, 2015.

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NCHS Data Brief  ■  No. 261  ■  October 2016
Summary
In 2015, roughly one-third of all office-based physicians had electronically sent, received,
integrated, or searched for patient health information from other providers. About 1 in 10
physicians had performed all four of these activities of electronic sharing of patient health
information with other providers.
The percentage of physicians who had electronically sent, received, integrated, or searched for
patient health information from other providers varied by state. The percentage of physicians
who had electronically sent patient health information to other providers ranged from 19.4% in
Idaho to 56.3% in Arizona, while the percentage of physicians who had electronically received
patient health information from other providers ranged from 23.6% in Louisiana and Mississippi
to 65.5% in Wisconsin. Physicians who had electronically integrated patient health information
from other providers also varied for office-based physicians by state, from 18.4% in Alaska to
49.3% in Delaware. In addition, physicians who had electronically searched for patient health
information from outside providers varied widely, from 15.1% in the District of Columbia to
61.2% in Oregon.
This report provides information about the state of interoperability among office-based physicians
in 2015. These four measures of electronic sharing of patient health information by physicians
will assist in tracking the progress outlined in the federal plan for achieving interoperability
(6,7). HITECH provides funding to states to establish an infrastructure that enables providers to
electronically share patient health information (8).

Definitions
Sharing patient health information across four aspects of interoperability: The 2015 National
Electronic Health Records Survey (NEHRS) asked physicians several questions about sending,
receiving, integrating, and searching for patient health information electronically:
●

Sending patient health information electronically: NEHRS asked physicians, “Do you
send patient health information to other providers and public health agencies outside your
medical organization using the following methods of data transmission?” Physicians who
answered “yes” to either the “EHR (not eFax)” or “Web Portal (separate from EHR)”
methods were defined as having electronically sent patient health information.

●

Receiving patient health information electronically: NEHRS asked physicians, “Do you
receive patient health information from other providers and public health agencies outside
your medical organization using the following methods of data transmission?” Physicians
who answered “yes” to either the “EHR (not eFax)” or “Web Portal (separate from EHR)”
methods were defined as having electronically received patient health information.

●

Integrating patient health information electronically: NEHRS asked physicians, “When
electronically receiving information from other providers, are you able to integrate the
following types of patient health information into your EHR without special effort like
manual entry or scanning?” The 10 different types of patient health information included:
medication lists, patient problem lists, medication and allergy lists, imaging reports,
laboratory results, registry data, referrals, hospital discharge summaries, emergency

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NCHS Data Brief  ■  No. 261  ■  October 2016
department notifications, and summary-of-care records for transitions of care or referrals.
Physicians who answered “yes” to at least one of the 10 different types of patient health
information were defined as having electronically integrated patient health information.
●

Searching patient health information electronically: NEHRS asked physicians, “How often
do you electronically search for health information from sources outside of your medical
organization when seeing a new patient or an existing patient who has received services
from other providers?” Physicians who answered “always,” “often,” or “sometimes” were
defined as having electronically searched for patient health information.

Data source and methods
Statistics are presented on data collected in the 2015 NEHRS. The NEHRS, which is conducted
by the National Center for Health Statistics and sponsored by the Office of the National
Coordinator for Health Information Technology, is a nationally representative mixed-mode survey
of office-based physicians that collects information on physician and practice characteristics,
including the adoption and use of EHR systems. NEHRS sampling design allows for both
national and state-based estimates of EHR adoption. NEHRS is conducted annually as a
sample survey of nonfederal office-based patient care physicians, excluding anesthesiologists,
radiologists, and pathologists.
The 2015 NEHRS estimates include a sample of 10,302 physicians, which is designed to produce
national and state-based estimates of office-based physicians. The 2015 NEHRS data collection
took place from August through December 2015, and it used a sequential mixed-mode design to
collect data through web, mail, and phone (4).
The overall unweighted response rate of the 2015 NEHRS questionnaire was 51.9% (49.2%
weighted). A copy of the 2015 NEHRS questionnaire is available from the NCHS website at:
http://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.
Statements of differences in estimates are based on statistical tests with significance at the
p < 0.05 level. All differences are statistically significant unless stated otherwise. Data analyses
were performed using the statistical package Stata version 14.0 (StataCorp LP, College Station, TX).

About the authors
Eric W. Jamoom and Ninee Yang are with the National Center for Health Statistics, Division of
Health Care Statistics, Ambulatory and Hospital Care Statistics Branch.

References
1. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records.
N Engl J Med 363(6):501–4. 2010.
2. Centers for Medicare & Medicaid Services. Electronic Health Records (EHR) Incentive
Programs. Baltimore, MD. Available from: https://www.cms.gov/ehrincentiveprograms/.
3. Jamoom EW, Yang N, Hing E. Adoption of certified electronic health record systems and
electronic information sharing in physician offices: United States, 2013 and 2014. NCHS data

■  7  ■

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For more NCHS Data Briefs, visit:
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NCHS Data Brief  ■  No. 261  ■  October 2016
brief, no 236. Hyattsville, MD: National Center for Health Statistics. 2016.
Available from: http://www.cdc.gov/nchs/products/databriefs/db236.htm.
4. Jamoom EW, Yang N, Hing E. Percentage of office-based physicians
using any electronic health records or electronic medical records, physicians
that have a basic system, and physicians that have a certified system, by state:
United States, 2014. 2015. Available from: http://www.cdc.gov/nchs/data/
ahcd/nehrs/2015_web_tables.pdf.
5. Jamoom EW, Yang N. Table of electronic health record adoption and use
among office-based physicians in the U.S., by state: 2015 National Electronic
Health Records Survey. 2016. Available from: http://www.cdc.gov/nchs/data/
ahcd/nehrs/2015_nehrs_web_table.pdf.
6. The Office of the National Coordinator for Health Information
Technology. Connecting health and care for the nation: A shared nationwide
interoperability roadmap Version 1.0. 2015. Available from:
https://www.healthit.gov/sites/default/files/hie-interoperability/nationwideinteroperability-roadmap-final-version-1.0.pdf.
7. The Office of the National Coordinator for Health Information
Technology. Federal health IT strategic plan: 2015–2020. 2015. Available
from: http://dashboard.healthit.gov/strategic-plan/federal-health-it-strategicplan-2015-2020.php.
8. Williams C, Mostashari F, Mertz K, Hogin E, Atwal P. From the Office
of the National Coordinator: The strategy for advancing the exchange of
health information. Health Aff (Millwood) 31(3):527–536. 2012.

Suggested citation
Jamoom EW, Yang N. State variation
in electronic sharing of information in
physician offices: United States, 2015.
NCHS data brief, no 261. Hyattsville, MD:
National Center for Health Statistics. 2016.

Copyright information
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the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.

National Center for Health
Statistics
Charles J. Rothwell, M.S., M.B.A., Director
Jennifer H. Madans, Ph.D., Associate
Director for Science
Division of Health Care Statistics
Denys T. Lau, Ph.D., Acting Director
Alexander Strashny, Ph.D., Associate
Director for Science

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