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

Abstract

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.

Readiness for the Patient-Centered Medical Home: Structural Capabilities of Massachusetts Primary Care Practices

“…39 Our findings are consistent with other studies showing that even among these smaller practices, larger size is associated with higher rates of EHR adoption and physician participation in quality improvement. 25,28,40,41 The lack of a consistent relationship between teaching status and structural capabilities may reflect competing organizational priorities within teaching practices. The association between network affiliation and EHR adoption was more complex than for other capabilities.…”

“…Prior research also suggests that this approach can be used to measure important aspects of physician practices. 28 Based on published literature and previously developed surveys on physician group characteristics, 25,[29][30][31][32][33][34] we defined 13 key capabilities that could be assessed by a survey of practicing physicians and classified them into 4 domains: patient assistance and reminders (assistance of patient selfmanagement, system for contacting patients for preventive services, clinical reminder systems); culture of quality (feedback to physicians on quality and patient experience, new initiatives on quality and patient experience, frequent meetings on quality performance, presence of a leader for quality improvement); enhanced access (language interpreters, providers' spoken languages, regular appointment hours on weekends); and electronic health records (frequently-used, multi-functional EHR) [Box]. Since the sophistication of EHRs may vary, the instrument assessed 6 specific EHR functionalities in 4 of the core areas identified by the Institute of Medicine: results management (lab and radiology results), communication and connectivity (notes from consultants), health information and data (problem and medication lists), and decision support (electronic reminders).…”

Knowledge sharing and health-care coordination: the role of creation and use brokers

“…The reasons for these problems with adoption and implementation are many and numerous, and are linked to the unique nature of healthcare settings (Fichman et al, 2011). On the one hand, many primary care practices are very small, making the costs of adopting prohibitively high (Simon et al, 2007). Moreover Miller and Sin (2004) indicate that financial benefits are uncertain and while appreciable in the long-term, in the short-term additional costs (in the form of decreased revenues) might occur from seeing fewer patients during the 'migration' process.…”

Medicare Part D—A Roundtable Discussion of Current Issues and Trends

“…Lack of computer skills, technical support, and time to learn about EHR systems were also reported by 59%, 66%, and 77%, respectively. 29 It seems that this skepticism is not without premise. In a systematic review of published literature, Poissant et al 30 evaluated the impact of EHRs on documentation time for physicians and nurses.…”

“…28 In Massachusetts, where almost half of physicians use EHR, a random stratified survey was mailed to 1,921 physician practices in 2005. 29 One physician from each practice was chosen at random to participant in the survey, and an alternative physician was selected in the event the initially chosen physician was no longer at the practice, had retired, or was deceased. Use of an EHR was evident in fewer than 25% of practices overall; larger practices were more likely to use EHR.…”