Correlates of electronic health record adoption in office practices: a statewide survey.

Full Abstract

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.

DESIGN:
Mailed survey to a stratified random sample of all medical practices in Massachusetts in 2005, with one physician per practice randomly selected for survey.

MEASUREMENTS:
EHR adoption rates.

RESULTS:
The response rate was 71% (1345/1884). Overall, while 45% of physicians were using an EHR, EHRs were present in only 23% of practices. In multivariate analysis, practice size was strongly correlated with EHR adoption; 52% of practices with 7 or more physicians had an EHR, as compared with 14% of solo practices (adjusted odds ratio, 3.66; 95% confidence interval, 2.28-5.87). Hospital-based practices (adjusted odds ratio, 2.44; 95% confidence interval, 1.53-3.91) and practices that teach medical students or residents (adjusted odds ratio, 2.30; 95% confidence interval, 1.60-3.31) were more likely to have an EHR. The most frequently cited barriers to adoption were start-up financial costs (84%), ongoing financial costs (82%), and loss of productivity (81%).

CONCLUSIONS:
While almost half of physicians in Massachusetts are using an EHR, fewer than one in four practices in Massachusetts have adopted EHRs. Adoption rates are lower in smaller practices, those not affiliated with hospitals, and those that do not teach medical students or residents. Interventions to expand EHR use must address both financial and non-financial barriers, especially among smaller practices.

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Author information

Author/s: Simon, Steven R (SR); Kaushal, Rainu (R); Cleary, Paul D (PD); Jenter, Chelsea A (CA); Volk, Lynn A (LA); Poon, Eric G (EG); Orav, E John (EJ); Lo, Helen G (HG); Williams, Deborah H (DH); Bates, David W (DW);

Affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215, USA. steven_simon(-atsign-)hphc.org

Grants: 1 UC1 HS015397 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Journal Article; Research Support, N.I.H., Extramural

Journal: Journal of the American Medical Informatics Association : JAMIA (J Am Med Inform Assoc), published in United States. (Language: eng)

Reference: -2007 Jan-Feb; vol 14 (issue 1) : pp 110-7

Dates: Created 2006/12/28; Completed 2007/03/15; Revised 2008/11/20;

PMID: 17068351, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Massachusetts
Medical Records Systems, Computerized - utilization
Organizational Culture
Practice Management, Medical - organization & administration
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