Chelsea Jenter - Academia.edu (original) (raw)

Papers by Chelsea Jenter

Research paper thumbnail of Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts

Informatics in primary care, 2008

The Massachusetts e-Health Collaborative (MAeHC) is implementing electronic health records (EHRs)... more The Massachusetts e-Health Collaborative (MAeHC) is implementing electronic health records (EHRs) in physicians' offices throughout three diverse communities. This study's objective was to assess the degree to which these practices are representative of physicians' practices statewide. We surveyed all MAeHC physicians (n=464) and compared their responses to those of a contemporaneously surveyed statewide random sample (n=1884). The survey questionnaire assessed practice characteristics related to EHR adoption, prevailing office culture related to quality and safety, attitudes toward health information technology (HIT) and perceptions of medical practice. A total of 355 MAeHC physicians (77%) and 1345 physicians from the statewide sample (71%) completed the survey. MAeHC practices resembled practices throughout Massachusetts in terms of practice size, physician age and gender, prevailing financial incentives for quality performance and HIT adoption and available resources...

Research paper thumbnail of Physician Satisfaction Following Electronic Health Record Adoption in Three Massachusetts Communities

Interactive Journal of Medical Research, 2012

Despite mandates and incentives for electronic health record (EHR) adoption, little is known abou... more Despite mandates and incentives for electronic health record (EHR) adoption, little is known about factors predicting physicians' satisfaction following EHR implementation. To measure predictors of physician satisfaction following EHR adoption. A total of 163 physicians completed a mailed survey before and after EHR implementation through a statewide pilot project in Massachusetts. Multivariable logistic regression identified predictors of physician satisfaction with their current practice situation in 2009 and generalized estimating equations accounted for clustering. The response rate was 77% in 2005 and 68% in 2009. In 2005, prior to EHR adoption, 28% of physicians were very satisfied with their current practice situation compared to 25% in 2009, following EHR adoption (P < .001). In multivariate analysis, physician satisfaction following EHR adoption was correlated with self-reported ease of EHR implementation (adjusted odds ratio [OR] = 5.7, 95% CI 2.1 - 16), resources for practice improvement (adjusted OR = 2.6, 95% CI 1.2 - 6.1), pre-intervention satisfaction (adjusted OR = 4.8, 95% CI 1.5 - 15), and stress (adjusted OR = 5.3, 95% CI 1.1 - 25). Male physicians reported lower satisfaction following EHR adoption (adjusted OR = 0.3, 95% CI 0.2 - 0.6). Interventions to expand EHR use should consider additional support for practices with fewer resources for improvement and ensure ease of EHR implementation. EHR adoption may be a factor in alleviating physicians' stress. Addressing physicians' satisfaction prior to practice transformation and anticipating greater dissatisfaction among male physicians will be essential to retaining the physician workforce and ensuring the quality of care they deliver.

Research paper thumbnail of Relationship Between Use of Electronic Health Record Features and Health Care Quality

Medical Care, 2010

Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision o... more Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision of high quality healthcare. However, evidence regarding their effectiveness for this purpose is mixed, and existing studies have generally considered EHR usage a binary factor and have not considered the availability and use of specific EHR features. To assess the relationship between the use of an EHR and the use of specific EHR features with quality of care. A statewide mail survey of physicians in Massachusetts conducted in 2005. The results of the survey were linked with Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, and generalized linear regression models were estimated to examine the associations between the use of EHRs and specific EHR features with quality measures, adjusting for physician practice characteristics. A stratified random sample of 1884 licensed physicians in Massachusetts, 1345 of whom responded. Of these, 507 had HEDIS measures available and were included in the analysis (measures are only available for primary care providers). Performance on HEDIS quality measures. The survey had a response rate of 71%. There was no statistically significant association between use of an EHR as a binary factor and performance on any of the HEDIS measure groups. However, there were statistically significant associations between the use of many, but not all, specific EHR features and HEDIS measure group scores. The associations were strongest for the problem list, visit note and radiology test result EHR features and for quality measures relating to women's health, colon cancer screening, and cancer prevention. For example, users of problem list functionality performed better on women's health, depression, colon cancer screening, and cancer prevention measures, with problem list users outperforming nonusers by 3.3% to 9.6% points on HEDIS measure group scores (all significant at the P < 0.05 level). However, these associations were not universal. Consistent with past studies, there was no significant relationship between use of EHR as a binary factor and performance on quality measures. However, availability and use of specific EHR features by primary care physicians was associated with higher performance on certain quality measures. These results suggest that, to maximize health care quality, developers, implementers and certifiers of EHRs should focus on increasing the adoption of robust EHR systems and increasing the use of specific features rather than simply aiming to deploy an EHR regardless of functionality.

Research paper thumbnail of Correlates of Electronic Health Record Adoption in Office Practices: A Statewide Survey

Journal of the American Medical Informatics Association, 2006

A b s t r a c t Objective: Despite emerging evidence that electronic health records (EHRs) can im... more A b s t r a c t Objective: Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption.

Research paper thumbnail of Physicians' Use of Key Functions in Electronic Health Records from 2005 to 2007: A Statewide Survey

Journal of the American Medical Informatics Association, 2009

OBJECTIVE Electronic health records (EHRs) have potential to improve quality and safety, but many... more OBJECTIVE Electronic health records (EHRs) have potential to improve quality and safety, but many physicians do not use these systems to full capacity. The objective of this study was to determine whether this usage gap is narrowing over time. DESIGN Follow-up mail survey of 1,144 physicians in Massachusetts who completed a 2005 survey. MEASUREMENTS Adoption of EHRs and availability and use of 10 EHR functions. RESULTS The response rate was 79.4%. In 2007, 35% of practices had EHRs, up from 23% in 2005. Among practices with EHRs, there was little change between 2005 and 2007 in the availability of nine of ten EHR features; the notable exception was electronic prescribing, reported as available in 44.7% of practices with EHRs in 2005 and 70.8% in 2007. Use of EHR functions changed inconsequentially, with more than one out of five physicians not using each available function regularly in both 2005 and 2007. Only electronic prescribing increased substantially: in 2005, 19.9% of physicians with this function available used it most or all the time, compared with 42.6% in 2007 (p < 0.001). CONCLUSIONS By 2007, more than one third of practices in Massachusetts reported having EHRs; the availability and use of electronic prescribing within these systems has increased. In contrast, physicians reported little change in the availability and use of other EHR functions. System refinements, certification efforts, and health policies, including standards development, should address the gaps in both EHR adoption and the use of key functions.

Research paper thumbnail of Physician attitudes toward health information exchange: results of a statewide survey

Journal of the American Medical Informatics Association, 2010

To assess physicians&... more To assess physicians' attitudes toward health information exchange (HIE) and physicians' willingness to pay to participate in HIE. We conducted a cross-sectional mail survey of 1296 licensed physicians (77% response rate) in Massachusetts in 2007. Perceptions of the potential effects of HIE on healthcare costs, quality of care, clinicians' time, patients' privacy concerns, and willingness to pay for HIE. After excluding 253 physicians who did not see any outpatients, we analyzed 1043 responses. Overall, 70% indicated that HIE would reduce costs, while 86% said it would improve quality and 76% believed that it would save time. On the other hand, 16% reported being very concerned about HIE's effect on privacy, while 55.0% were somewhat concerned and 29% not at all concerned. Slightly more than half of the physicians (54%) said they would be willing to pay an unspecified monthly fee to participate in HIE, but only 37% said they would be willing to pay $150 per month for it. Primary care physicians and those in larger practices tended to have more positive attitudes toward HIE. Physicians perceive that HIE will have generally positive effects, though a considerable fraction harbor concerns about privacy. While physicians may be willing to participate in HIE, they are not consistently willing to pay to participate. HIE business models that require substantial physician subscription fees may face significant challenges.

Research paper thumbnail of Factors associated with difficult electronic health record implementation in office practice

Journal of the American Medical Informatics Association, 2012

Little is known about physicians&... more Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success.

Research paper thumbnail of Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use?

Journal of the American Medical Informatics Association, 2012

Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs... more Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs have the potential to improve quality and safety. However, physicians are reluctant to implement EHRs due to financial constraints, usability concerns, and apprehension about unintended consequences, including the introduction of medical errors related to EHR use. The goal of this study was to characterize and describe physicians' attitudes towards three consequences of EHR implementation: (1) the potential for EHRs to introduce new errors; (2) improvements in healthcare quality; and (3) changes in overall physician satisfaction. Using data from a 2007 statewide survey of Massachusetts physicians, we conducted multivariate regression analysis to examine relationships between practice characteristics, perceptions of EHR-related errors, perceptions of healthcare quality, and overall physician satisfaction. 30% of physicians agreed that EHRs create new opportunities for error, but only 2% believed their EHR has created more errors than it prevented. With respect to perceptions of quality, there was no significant association between perceptions of EHR-associated errors and perceptions of EHR-associated changes in healthcare quality. Finally, physicians who believed that EHRs created new opportunities for error were less likely be satisfied with their practice situation (adjusted OR 0.49, p=0.001). Almost one third of physicians perceived that EHRs create new opportunities for error. This perception was associated with lower levels of physician satisfaction.

Research paper thumbnail of Ambulatory prescribing errors among community-based providers in two states

Journal of the American Medical Informatics Association, 2012

Objective Little is known about the frequency and types of prescribing errors in the ambulatory s... more Objective Little is known about the frequency and types of prescribing errors in the ambulatory setting among community-based, primary care providers. Therefore, the rates and types of prescribing errors were assessed among community-based, primary care providers in two states. Material and Methods A non-randomized crosssectional study was conducted of 48 providers in New York and 30 providers in Massachusetts, all of whom used paper prescriptions, from September 2005 to November 2006. Using standardized methodology, prescriptions and medical records were reviewed to identify errors. Results 9385 prescriptions were analyzed from 5955 patients. The overall prescribing error rate, excluding illegibility errors, was 36.7 per 100 prescriptions (95% CI 30.7 to 44.0) and did not vary significantly between providers from each state (p¼0.39). One or more nonillegibility errors were found in 28% of prescriptions. Rates of illegibility errors were very high (175.0 per 100 prescriptions, 95% CI 169.1 to 181.3). Inappropriate abbreviation and direction errors also occurred frequently (13.4 and 4.2 errors per 100 prescriptions, respectively). Reviewers determined that the vast majority of errors could have been eliminated through the use of eprescribing with clinical decision support. Discussion Prescribing errors appear to occur at very high rates among community-based primary care providers, especially when compared with studies of academic-affiliated providers that have found nearly threefold lower error rates. Illegibility errors are particularly problematical. Conclusions Further characterizing prescribing errors of community-based providers may inform strategies to improve ambulatory medication safety, especially eprescribing. Trial registration number http://www.clinicaltrials. gov, NCT00225576.

Research paper thumbnail of Ability to Generate Patient Registries Among Practices With and Without Electronic Health Records

Journal of Medical Internet Research, 2009

The ability to generate registries of patients with particular clinical attributes, such as diagn... more The ability to generate registries of patients with particular clinical attributes, such as diagnoses or medications taken, is central to measuring and improving the quality of health care. However, it is not known how many providers have the ability to generate such registries. To assess the proportion of physician practices that can construct registries of patients with specific diagnoses, laboratory results, or medications, and to determine the relationship between electronic health record (EHR) usage and the ability to perform registry functions. We conducted a mail survey of a stratified random sample of physician practices in Massachusetts in the northeastern United States (N = 1884). The survey included questions about the physicians' ability to generate diagnosis, laboratory result, and medication registries; the presence of EHR; and usage of specific EHR features. The response rate was 71% (1345/1884). Overall, 79.8% of physician practices reported being able to generate registries of patients by diagnosis; 56.1% by laboratory result; and 55.8% by medication usage. In logistic regression analyses, adjusting for urban/rural location, practice size and ownership, teaching status, hospital affiliation, and specialty, physician practices with an EHR were more likely to be able to construct diagnosis registries (adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.25 - 1.86), laboratory registries (OR 1.42, 95% CI 1.22 - 1.66), and medication registries (OR 2.30, 95% CI 1.96 - 2.70). Many physician practices were able to generate registries, but this capability is far from universal. Adoption of EHRs appears to be a useful step toward this end, and practices with EHRs are considerably more likely to be able to carry out registry functions. Because practices need registries to perform broad-based quality improvement, they should consider adopting EHRs that have built-in registry functionality.

Research paper thumbnail of Electronic health records: Use, barriers and satisfaction among physicians who care for black and Hispanic patients

Journal of Evaluation in Clinical Practice, 2009

Objectives Electronic health records (EHRs) are a promising tool to improve the quality of health... more Objectives Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers. Methods We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems. Results Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care. Conclusions In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minorityserving providers have equal access to EHR systems, we failed to find evidence of a new digital divide.

Research paper thumbnail of Massachusetts E-Health Project Increased Physicians' Ability To Use Registries, And Signals Progress Toward Better Care

Health Affairs, 2011

The ability to generate and use registries--lists of patients with specific conditions, medicatio... more The ability to generate and use registries--lists of patients with specific conditions, medications, or test results--is considered a measure of physicians' engagement with electronic health record systems and a proxy for high-quality health care. We conducted a pre-post survey of registry capability among physicians participating in the Massachusetts eHealth Collaborative, a four-year, $50 million health information technology program. Physicians who participated in the program increased their ability to generate some types of registries--specifically, for laboratory results and medication use. Our analysis also suggested that physicians who used their electronic health records more intensively were more likely to use registries, particularly in caring for patients with diabetes, compared to physicians reporting less avid use of electronic health records. This statewide project may be a viable model for regional efforts to expand health information technology and improve the quality of care.

Research paper thumbnail of Physicians and Electronic Health Records

Archives of Internal Medicine, 2007

Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit... more Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit documentation to laboratory test ordering, but little is known about physicians' actual use of these functions.

Research paper thumbnail of Electronic Health Records and Malpractice Claims in Office Practice

Archives of Internal Medicine, 2008

Background: Electronic health records (EHRs) may improve patient safety and health care quality, ... more Background: Electronic health records (EHRs) may improve patient safety and health care quality, but the relationship between EHR adoption and settled malpractice claims is unknown.

Research paper thumbnail of The Relationship Between Electronic Health Records and Malpractice Claims

Archives of Internal Medicine, 2012

Electronic health records (EHRs) have the potential to advance the quality of care, but studies h... more Electronic health records (EHRs) have the potential to advance the quality of care, but studies have shown mixed results. The authors sought to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability.

Research paper thumbnail of Use of features in electronic health records and health care quality: How are they related?

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007

Research paper thumbnail of Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts

Informatics in primary care, 2008

The Massachusetts e-Health Collaborative (MAeHC) is implementing electronic health records (EHRs)... more The Massachusetts e-Health Collaborative (MAeHC) is implementing electronic health records (EHRs) in physicians' offices throughout three diverse communities. This study's objective was to assess the degree to which these practices are representative of physicians' practices statewide. We surveyed all MAeHC physicians (n=464) and compared their responses to those of a contemporaneously surveyed statewide random sample (n=1884). The survey questionnaire assessed practice characteristics related to EHR adoption, prevailing office culture related to quality and safety, attitudes toward health information technology (HIT) and perceptions of medical practice. A total of 355 MAeHC physicians (77%) and 1345 physicians from the statewide sample (71%) completed the survey. MAeHC practices resembled practices throughout Massachusetts in terms of practice size, physician age and gender, prevailing financial incentives for quality performance and HIT adoption and available resources...

Research paper thumbnail of Physician Satisfaction Following Electronic Health Record Adoption in Three Massachusetts Communities

Interactive Journal of Medical Research, 2012

Despite mandates and incentives for electronic health record (EHR) adoption, little is known abou... more Despite mandates and incentives for electronic health record (EHR) adoption, little is known about factors predicting physicians' satisfaction following EHR implementation. To measure predictors of physician satisfaction following EHR adoption. A total of 163 physicians completed a mailed survey before and after EHR implementation through a statewide pilot project in Massachusetts. Multivariable logistic regression identified predictors of physician satisfaction with their current practice situation in 2009 and generalized estimating equations accounted for clustering. The response rate was 77% in 2005 and 68% in 2009. In 2005, prior to EHR adoption, 28% of physicians were very satisfied with their current practice situation compared to 25% in 2009, following EHR adoption (P < .001). In multivariate analysis, physician satisfaction following EHR adoption was correlated with self-reported ease of EHR implementation (adjusted odds ratio [OR] = 5.7, 95% CI 2.1 - 16), resources for practice improvement (adjusted OR = 2.6, 95% CI 1.2 - 6.1), pre-intervention satisfaction (adjusted OR = 4.8, 95% CI 1.5 - 15), and stress (adjusted OR = 5.3, 95% CI 1.1 - 25). Male physicians reported lower satisfaction following EHR adoption (adjusted OR = 0.3, 95% CI 0.2 - 0.6). Interventions to expand EHR use should consider additional support for practices with fewer resources for improvement and ensure ease of EHR implementation. EHR adoption may be a factor in alleviating physicians' stress. Addressing physicians' satisfaction prior to practice transformation and anticipating greater dissatisfaction among male physicians will be essential to retaining the physician workforce and ensuring the quality of care they deliver.

Research paper thumbnail of Relationship Between Use of Electronic Health Record Features and Health Care Quality

Medical Care, 2010

Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision o... more Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision of high quality healthcare. However, evidence regarding their effectiveness for this purpose is mixed, and existing studies have generally considered EHR usage a binary factor and have not considered the availability and use of specific EHR features. To assess the relationship between the use of an EHR and the use of specific EHR features with quality of care. A statewide mail survey of physicians in Massachusetts conducted in 2005. The results of the survey were linked with Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, and generalized linear regression models were estimated to examine the associations between the use of EHRs and specific EHR features with quality measures, adjusting for physician practice characteristics. A stratified random sample of 1884 licensed physicians in Massachusetts, 1345 of whom responded. Of these, 507 had HEDIS measures available and were included in the analysis (measures are only available for primary care providers). Performance on HEDIS quality measures. The survey had a response rate of 71%. There was no statistically significant association between use of an EHR as a binary factor and performance on any of the HEDIS measure groups. However, there were statistically significant associations between the use of many, but not all, specific EHR features and HEDIS measure group scores. The associations were strongest for the problem list, visit note and radiology test result EHR features and for quality measures relating to women's health, colon cancer screening, and cancer prevention. For example, users of problem list functionality performed better on women's health, depression, colon cancer screening, and cancer prevention measures, with problem list users outperforming nonusers by 3.3% to 9.6% points on HEDIS measure group scores (all significant at the P < 0.05 level). However, these associations were not universal. Consistent with past studies, there was no significant relationship between use of EHR as a binary factor and performance on quality measures. However, availability and use of specific EHR features by primary care physicians was associated with higher performance on certain quality measures. These results suggest that, to maximize health care quality, developers, implementers and certifiers of EHRs should focus on increasing the adoption of robust EHR systems and increasing the use of specific features rather than simply aiming to deploy an EHR regardless of functionality.

Research paper thumbnail of Correlates of Electronic Health Record Adoption in Office Practices: A Statewide Survey

Journal of the American Medical Informatics Association, 2006

A b s t r a c t Objective: Despite emerging evidence that electronic health records (EHRs) can im... more A b s t r a c t Objective: Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption.

Research paper thumbnail of Physicians' Use of Key Functions in Electronic Health Records from 2005 to 2007: A Statewide Survey

Journal of the American Medical Informatics Association, 2009

OBJECTIVE Electronic health records (EHRs) have potential to improve quality and safety, but many... more OBJECTIVE Electronic health records (EHRs) have potential to improve quality and safety, but many physicians do not use these systems to full capacity. The objective of this study was to determine whether this usage gap is narrowing over time. DESIGN Follow-up mail survey of 1,144 physicians in Massachusetts who completed a 2005 survey. MEASUREMENTS Adoption of EHRs and availability and use of 10 EHR functions. RESULTS The response rate was 79.4%. In 2007, 35% of practices had EHRs, up from 23% in 2005. Among practices with EHRs, there was little change between 2005 and 2007 in the availability of nine of ten EHR features; the notable exception was electronic prescribing, reported as available in 44.7% of practices with EHRs in 2005 and 70.8% in 2007. Use of EHR functions changed inconsequentially, with more than one out of five physicians not using each available function regularly in both 2005 and 2007. Only electronic prescribing increased substantially: in 2005, 19.9% of physicians with this function available used it most or all the time, compared with 42.6% in 2007 (p < 0.001). CONCLUSIONS By 2007, more than one third of practices in Massachusetts reported having EHRs; the availability and use of electronic prescribing within these systems has increased. In contrast, physicians reported little change in the availability and use of other EHR functions. System refinements, certification efforts, and health policies, including standards development, should address the gaps in both EHR adoption and the use of key functions.

Research paper thumbnail of Physician attitudes toward health information exchange: results of a statewide survey

Journal of the American Medical Informatics Association, 2010

To assess physicians&... more To assess physicians' attitudes toward health information exchange (HIE) and physicians' willingness to pay to participate in HIE. We conducted a cross-sectional mail survey of 1296 licensed physicians (77% response rate) in Massachusetts in 2007. Perceptions of the potential effects of HIE on healthcare costs, quality of care, clinicians' time, patients' privacy concerns, and willingness to pay for HIE. After excluding 253 physicians who did not see any outpatients, we analyzed 1043 responses. Overall, 70% indicated that HIE would reduce costs, while 86% said it would improve quality and 76% believed that it would save time. On the other hand, 16% reported being very concerned about HIE's effect on privacy, while 55.0% were somewhat concerned and 29% not at all concerned. Slightly more than half of the physicians (54%) said they would be willing to pay an unspecified monthly fee to participate in HIE, but only 37% said they would be willing to pay $150 per month for it. Primary care physicians and those in larger practices tended to have more positive attitudes toward HIE. Physicians perceive that HIE will have generally positive effects, though a considerable fraction harbor concerns about privacy. While physicians may be willing to participate in HIE, they are not consistently willing to pay to participate. HIE business models that require substantial physician subscription fees may face significant challenges.

Research paper thumbnail of Factors associated with difficult electronic health record implementation in office practice

Journal of the American Medical Informatics Association, 2012

Little is known about physicians&... more Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success.

Research paper thumbnail of Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use?

Journal of the American Medical Informatics Association, 2012

Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs... more Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs have the potential to improve quality and safety. However, physicians are reluctant to implement EHRs due to financial constraints, usability concerns, and apprehension about unintended consequences, including the introduction of medical errors related to EHR use. The goal of this study was to characterize and describe physicians' attitudes towards three consequences of EHR implementation: (1) the potential for EHRs to introduce new errors; (2) improvements in healthcare quality; and (3) changes in overall physician satisfaction. Using data from a 2007 statewide survey of Massachusetts physicians, we conducted multivariate regression analysis to examine relationships between practice characteristics, perceptions of EHR-related errors, perceptions of healthcare quality, and overall physician satisfaction. 30% of physicians agreed that EHRs create new opportunities for error, but only 2% believed their EHR has created more errors than it prevented. With respect to perceptions of quality, there was no significant association between perceptions of EHR-associated errors and perceptions of EHR-associated changes in healthcare quality. Finally, physicians who believed that EHRs created new opportunities for error were less likely be satisfied with their practice situation (adjusted OR 0.49, p=0.001). Almost one third of physicians perceived that EHRs create new opportunities for error. This perception was associated with lower levels of physician satisfaction.

Research paper thumbnail of Ambulatory prescribing errors among community-based providers in two states

Journal of the American Medical Informatics Association, 2012

Objective Little is known about the frequency and types of prescribing errors in the ambulatory s... more Objective Little is known about the frequency and types of prescribing errors in the ambulatory setting among community-based, primary care providers. Therefore, the rates and types of prescribing errors were assessed among community-based, primary care providers in two states. Material and Methods A non-randomized crosssectional study was conducted of 48 providers in New York and 30 providers in Massachusetts, all of whom used paper prescriptions, from September 2005 to November 2006. Using standardized methodology, prescriptions and medical records were reviewed to identify errors. Results 9385 prescriptions were analyzed from 5955 patients. The overall prescribing error rate, excluding illegibility errors, was 36.7 per 100 prescriptions (95% CI 30.7 to 44.0) and did not vary significantly between providers from each state (p¼0.39). One or more nonillegibility errors were found in 28% of prescriptions. Rates of illegibility errors were very high (175.0 per 100 prescriptions, 95% CI 169.1 to 181.3). Inappropriate abbreviation and direction errors also occurred frequently (13.4 and 4.2 errors per 100 prescriptions, respectively). Reviewers determined that the vast majority of errors could have been eliminated through the use of eprescribing with clinical decision support. Discussion Prescribing errors appear to occur at very high rates among community-based primary care providers, especially when compared with studies of academic-affiliated providers that have found nearly threefold lower error rates. Illegibility errors are particularly problematical. Conclusions Further characterizing prescribing errors of community-based providers may inform strategies to improve ambulatory medication safety, especially eprescribing. Trial registration number http://www.clinicaltrials. gov, NCT00225576.

Research paper thumbnail of Ability to Generate Patient Registries Among Practices With and Without Electronic Health Records

Journal of Medical Internet Research, 2009

The ability to generate registries of patients with particular clinical attributes, such as diagn... more The ability to generate registries of patients with particular clinical attributes, such as diagnoses or medications taken, is central to measuring and improving the quality of health care. However, it is not known how many providers have the ability to generate such registries. To assess the proportion of physician practices that can construct registries of patients with specific diagnoses, laboratory results, or medications, and to determine the relationship between electronic health record (EHR) usage and the ability to perform registry functions. We conducted a mail survey of a stratified random sample of physician practices in Massachusetts in the northeastern United States (N = 1884). The survey included questions about the physicians' ability to generate diagnosis, laboratory result, and medication registries; the presence of EHR; and usage of specific EHR features. The response rate was 71% (1345/1884). Overall, 79.8% of physician practices reported being able to generate registries of patients by diagnosis; 56.1% by laboratory result; and 55.8% by medication usage. In logistic regression analyses, adjusting for urban/rural location, practice size and ownership, teaching status, hospital affiliation, and specialty, physician practices with an EHR were more likely to be able to construct diagnosis registries (adjusted odds ratio [OR] 1.53, 95% confidence interval [CI] 1.25 - 1.86), laboratory registries (OR 1.42, 95% CI 1.22 - 1.66), and medication registries (OR 2.30, 95% CI 1.96 - 2.70). Many physician practices were able to generate registries, but this capability is far from universal. Adoption of EHRs appears to be a useful step toward this end, and practices with EHRs are considerably more likely to be able to carry out registry functions. Because practices need registries to perform broad-based quality improvement, they should consider adopting EHRs that have built-in registry functionality.

Research paper thumbnail of Electronic health records: Use, barriers and satisfaction among physicians who care for black and Hispanic patients

Journal of Evaluation in Clinical Practice, 2009

Objectives Electronic health records (EHRs) are a promising tool to improve the quality of health... more Objectives Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers. Methods We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems. Results Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care. Conclusions In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minorityserving providers have equal access to EHR systems, we failed to find evidence of a new digital divide.

Research paper thumbnail of Massachusetts E-Health Project Increased Physicians' Ability To Use Registries, And Signals Progress Toward Better Care

Health Affairs, 2011

The ability to generate and use registries--lists of patients with specific conditions, medicatio... more The ability to generate and use registries--lists of patients with specific conditions, medications, or test results--is considered a measure of physicians' engagement with electronic health record systems and a proxy for high-quality health care. We conducted a pre-post survey of registry capability among physicians participating in the Massachusetts eHealth Collaborative, a four-year, $50 million health information technology program. Physicians who participated in the program increased their ability to generate some types of registries--specifically, for laboratory results and medication use. Our analysis also suggested that physicians who used their electronic health records more intensively were more likely to use registries, particularly in caring for patients with diabetes, compared to physicians reporting less avid use of electronic health records. This statewide project may be a viable model for regional efforts to expand health information technology and improve the quality of care.

Research paper thumbnail of Physicians and Electronic Health Records

Archives of Internal Medicine, 2007

Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit... more Background: Electronic health records (EHRs) allow for a variety of functions, ranging from visit documentation to laboratory test ordering, but little is known about physicians' actual use of these functions.

Research paper thumbnail of Electronic Health Records and Malpractice Claims in Office Practice

Archives of Internal Medicine, 2008

Background: Electronic health records (EHRs) may improve patient safety and health care quality, ... more Background: Electronic health records (EHRs) may improve patient safety and health care quality, but the relationship between EHR adoption and settled malpractice claims is unknown.

Research paper thumbnail of The Relationship Between Electronic Health Records and Malpractice Claims

Archives of Internal Medicine, 2012

Electronic health records (EHRs) have the potential to advance the quality of care, but studies h... more Electronic health records (EHRs) have the potential to advance the quality of care, but studies have shown mixed results. The authors sought to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability.

Research paper thumbnail of Use of features in electronic health records and health care quality: How are they related?

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2007