Predictors of success for electronic health record implementation in small physician practices

Abstract

SummaryBackground: The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives: Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods: This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results: Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 -26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions: A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them.

Disparities in Primary Care EHR Adoption Rates

“…12 A survey of 544 small practices by Ancker et al found EHR implementation success to be associated with practices that treated fewer Medicaid and uninsured patients. 13 …”

The Effect of Electronic Health Record Implementation on Community Emergency Department Operational Measures of Performance

“…This could be the result of better preparation through the use of clinical champions, better organizational buy-in, effective leadership and change management and ultimate commitment to information technology that contribute to an ED's response to EHR implementation. 36–38 Qualitative methods may be well suited to better understanding why facilities respond the way they do and how they can affect workflow delivered in a healthcare setting. 27,39 By mitigating inefficiencies gained by implementing EHRs, we may enhance the overall benefit of an electronic record and the subsequent value delivered to the patient and the healthcare system.…”

Do provider attitudes about electronic health records predict future electronic health record use?

“…12,13,18,19 For example, a study by Ancker and colleagues found that in interviews with PCIP providers, positive attitudes about EHRs correlated with successful EHR implementation. 12 Our findings suggest that once an EHR is in place, prior comfort with computers and attitudes about the EHR do not predict future use of that EHR. These findings differ from findings of EHR adoption studies and may signify that once providers have overcome the hurdle of adopting an EHR, their attitudes about it do not affect their future use of EHR functions.…”

“…12–15 However, to our knowledge, there is no evidence on whether comfort with technology and more positive attitudes about EHRs prior to implementation affect use of EHRs once they are implemented. We hypothesize that providers who are comfortable using computers and who feel optimistic about their potential effects on patient care might use more features of the EHR.…”