The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others. Physicians' electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention.A ccelerating the adoption of health information technology (IT) has been recognized as a national policy priority for more than a decade. HITECH's goals are to promote the adoption and use of interoperable electronic health records (EHRs) and health information exchange (HIE), which can serve as the foundation for improvements in the cost and quality of the US health care delivery system. 3 In particular, modernizing the country's health IT infrastructure enables broader efforts to pursue new models of care delivery. To help move the country toward this goal, beginning in 2011 the Centers for Medicare and Medicaid Services (CMS) began making incentive payments to eligible professionals who demonstrated the regular use of specific computerized capabilities that meet meaningful-use objectives. 4Early evidence on the impact of HITECH suggested that its investments had accelerated the rate of EHR adoption. From 2010 to 2012 adoption of basic EHR systems and specific meaningful-use capabilities grew rapidly among US ambulatory care physicians. 5Physicians who previously had significantly lower rates of adoption, 6 including those who were older or worked in rural areas or areas with high rates of poverty, had the highest relative gains.

This study demonstrated a causal relationship between the multifaceted intervention and the reduced central line-associated bloodstream infections. Both groups decreased infection rates after implementation and sustained these results over time, replicating the results found in previous, pre-post studies of this multifaceted intervention and providing further evidence that most central line-associated bloodstream infections are preventable.

Admission rates for most ACSCs, except for diabetes, did not change in the post-SARS period. The reductions in outpatient utilization during the SARS outbreak did not appear to affect adversely admissions for most ACSCs.

PURPOSE Realizing the benefi ts of adopting electronic health records (EHRs) in large measure depends heavily on clinicians and providers' uptake and meaningful use of the technology. This study examines EHR adoption among family physicians using 2 different data sources, compares family physicians with other offi ce-based medical specialists, assesses variation in EHR adoption among family physicians across states, and shows the possibility for data sharing among various medical boards and federal agencies in monitoring and guiding EHR adoption. METHODWe undertook a secondary analysis of American Board of Family Medicine (ABFM) administrative data (2005)(2006)(2007)(2008)(2009)(2010)(2011) and data from the National Ambulatory Medical Care Survey (NAMCS) (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011). RESULTSThe EHR adoption rate by family physicians reached 68% nationally in 2011. NAMCS family physician adoption rates and ABFM adoption rates (2005)(2006)(2007)(2008)(2009)(2010)(2011) were similar. Family physicians are adopting EHRs at a higher rate than other offi ce-based physicians as a group; however, signifi cant state-level variation exists, indicating geographical gaps in EHR adoption.CONCLUSION Two independent data sets yielded convergent results, showing that adoption of EHRs by family physicians has doubled since 2005, exceeds other offi ce-based physicians as a group, and is likely to surpass 80% by 2013. Adoption varies at a state level. Further monitoring of trends in EHR adoption and characterizing their capacities are important to achieve comprehensive data exchange necessary for better, affordable health care. 2013;11:14-19. doi:10.1370/afm.1461. Ann Fam Med INTRODUCTIONE lectronic health records (EHRs) are generally expected to improve the quality of health care, lower health care costs, and provide patients with more involvement in their own health care.1,2 Federal efforts to increase adoption of EHRs have accelerated in recent years, especially with the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which created the Health Information Technology Regional Extension Centers (RECs). Sixty-two RECs were set up across the nation and awarded $657 million in federal funding in 2010.3 The Centers for Medicare & Medicaid Services (CMS) also have set up incentives for adoption and meaningful use of EHRs and penalties for lack of provider engagement. 4 The realization of EHR benefi ts depends heavily on health providers' uptake of this technology. The Triple Aim initiative aspires to improve population health and health care delivery in the United States while controlling costs. 5 The federal e-health directives outlined in the Health Insurance Portability and Accountability Act (HIPAA) 15 EL EC T RONIC HE A LT H R ECOR D A D OP T IONCare Act. 6 Realization of the Triple Aim will require data sharing and exchange that transects all aspects of health care delivery and depend in part on widespread adoption of EHRs, particularly by offi ce...

It is widely believed that health care quality affects primary care outcomes, but the evidence is fragmented and incomplete. The authors searched MEDLINE for relevant articles published between 1950 and 2006 and reviewed the evidence to assess the relationship between the personal aspects of primary care quality and patients' health status and health services utilization. These personal aspects, which include patient-physician continuity and communication, are distinct from the technical aspects of primary care, which include ordering tests, treatments, and referrals. Fourteen articles met the inclusion criteria. Results showed that greater continuity of care is associated with less use of hospitals and emergency departments and lower health care costs; effective communication may be associated with better health status. The limited available evidence suggests that higher quality in the personal aspects of primary care is associated with some but not all outcomes of care. Additional research is needed to define these relationships more clearly.