Correlates of Electronic Health Record Adoption in Office Practices: A Statewide Survey (original) (raw)
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Factors Influencing Family Physician Adoption of Electronic Health Records (EHRs)
The Journal of the American Board of Family Medicine, 2013
Background: Physician and practice characteristics associated with family physician adoption of electronic health records (EHRs) remain largely unexplored but may be important for tailoring policies and interventions. Methods: This was a cross-sectional study of EHR adoption using American Board of Family Medicine certification census data (2006-2011) for over 41,000 family physicians to test associations between demographic, geographic, and practice characteristics and EHR adoption. Results: EHR adoption rates for family physicians grew from 37% in 2006 to 68% in 2011. No significant association was found with rural status (odds ration [OR], 0.985; 95% confidence interval [CI], 0.932-1.042). Practicing in a medically underserved location (OR, 0.868; 95% CI, 0.822-0.917) or geographic health professional shortage areas (OR, 0.904; 95% CI, 0.831-0.984), or being an international medical graduate (OR, 0.769; 95% CI, 0.748-0.846) were negatively associated with adoption. Compared with physicians in group practices, physicians in solo practices (OR, 0.465; 95% CI, 0.439-0.493) and small practices (OR, 0.769; 95% CI, 0.720-0.820) were less likely to adopt EHRs, whereas those in health maintenance organizations (OR, 5.482; 95% CI, 4.657-6.454) or with faculty status (OR, 1.527; 95% CI, 1.386-1.684) were more likely. Conclusions: Variation in EHR adoption is associated with physician and practice characteristics that may help guide intervention. These findings may be important to other specialties and could instruct interventions to improve adoption. Certification boards could play an important role in tracking EHR adoption and help target resources and facilitation.
Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions
American Journal of Medical Quality, 2007
Many functions important to realizing the full potential from electronic health records (EHRs) may not be selected by all physicians using EHRs in the ambulatory setting. This article examines the extent to which EHR systems used by Florida physicians include functionalities that the Institute of Medicine has designated as being critical for optimal performance. Results indicate that EHR systems used by recent adopters, when compared with early adopters, appear to be missing key patient safety and cost control functions. Overall, many physicians are only partially adopting EHR technologies, suggesting that published adoption rates may be exaggerating the true rate of diffusion.
Electronic health records in small physician practices: availability, use, and perceived benefits
Journal of the American Medical Informatics Association, 2011
Objective To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size. Design Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association. Measurements We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care. Results With a response rate of 62%, we found that <2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21e46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13e16%) and statistically significant (p<0.001). All adopters reported similar benefits. Limitations Although we have adjusted for response bias, influences may still exist. Conclusion Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.
Health Care Management Review, 2010
Background: Health information technologies, such as electronic health records (EHRs), can potentially improve patient safety in our health care system. The potential advantages include increased quality and more efficiency in the care of patients. Adoption of EHRs has been slow despite these advantages and a national call for EHR implementation. Purposes: This article explores factors associated with the adoption of EHR systems using organizational theory to derive hypotheses as to why physicians would adopt EHRs. Methodology/Approach: A survey was administered to all office-based physicians in Nebraska and South Dakota using a modified Dillman technique between July and November 2007. The main outcome variable measured physician EHR adoption status at three levels: not planning to use an EHR, planning to use an EHR, and using an EHR. Factors associated with EHR status were analyzed using a multinomial logistic regression. Findings: Approximately 30% of physicians reported using an EHR in his or her practice. Physicians adopting EHRs were younger and had access to internal health information technologies support. In addition, working in an independent practice decreased the likelihood of physicians using and adopting EHRs.
Individual, Organizational, and Technological Barriers to EHR Implementation
Cases on Healthcare Information Technology for Patient Care Management
This case examines the adoption and implementation of an electronic health record in a regional medical center in Midwest, USA. A background of the organization is provided, including a discussion of the organization’s inception, financials, and organizational structure. A brief literature review of technology adoption, use, and performance is presented, followed by a discussion of data analysis techniques and results. A detailed overview of specific technology, management, and organizational concerns is presented along with challenges and solutions. The objective of this case is to highlight the challenges and opportunities during electronic health record adoption and implementation. The hope is that educators and students alike will appreciate the complexity of health information technology adoption and implementation through specific examples of challenges and solutions. While the information contained in this case is indeed specific to one organization in the USA, the lessons le...
Research Paper: Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless
J Amer Med Inform Assoc, 2009
ObjectiveThe purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al.1 The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption.DesignMeta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a “Universal EHR Adoption” by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices.MeasurementEHR adoption parameters—external and internal coefficients of influence—are estimated using bass diffusion models and future adoption rates are projected.ResultsComparing the EHR adoption rates before and after 2004 (2001–2004 and 2001–2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%).ConclusionsThe external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion.
The influence of payer mix on electronic health record adoption by physicians
Health Care Management Review, 2007
Background: Numerous studies have examined the relationship between physician practice characteristics and electronic health record (EHR) adoption. Little is known about how payer mix influences physicians' decisions to implement EHR systems. Purpose: This study examines how different proportions of Medicare, Medicaid, and privately insured patients in physicians' practices influence EHR adoption. Methodology: Data from a large-scale survey of physician's use of information technologies in Florida were analyzed. Physicians were categorized based on their responses to questions regarding the proportion of patients in their practice that use Medicare, Medicaid, or private insurance products. The binary dependent variable of interest was EHR adoption among physicians. Adjusted odds ratios (ORs) were computed using logistic regression modeling techniques. The model examined the effect of changes in each payer type on EHR adoption, controlling for various practice characteristics. Findings: Physicians with the highest percentage of Medicaid patients in their practices were significantly less likely to indicate using an EHR system when compared with those in the low-volume Medicaid group (OR = 0.690; 95% confidence interval [CI] = 0.50-0.95). No differences in EHR adoption were detected among physicians in the low, median, and high Medicare volume classifications. Among the private payer classifications, physicians whose practices were in the median group indicated significantly greater EHR use than those with relatively low levels of privately insured patients (OR = 1.62; 95% CI = 1.16-2.27). Those in the high-volume private payer group were also more likely than the low-volume group to have an EHR system, but this trend did not reach statistical significance (OR = 1.44; 95% CI = 0.96-2.16).
Health affairs (Project Hope), 2014
Federally qualified health centers play an important role in providing health care to underserved populations. Recent substantial federal investments in health information technology have enabled health centers to expand their use of electronic health record (EHR) systems, but factors associated with adoption are not clear. We examined 2010-12 administrative data from the Health Resources and Services Administration's Uniform Data System for more than 1,100 health centers. We found that in 2012 nine out of ten health centers had adopted a EHR system, and half had adopted EHRs with basic capabilities. Seven in ten health centers reported that their providers were receiving meaningful-use incentive payments from the Centers for Medicare and Medicaid Services (CMS). Only one-third of health centers had EHR systems that could meet CMS's stage 1 meaningful-use core requirements. Health centers that met the stage 1 requirements had more than twice the odds of receiving quality rec...