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...

Access to health care is critical for the health status of American children. The provider workforce available to care for children in the United States continues to grow relative to birth rate and the concomitant growth in the number of young patients, although there remains significant maldistribution, with many communities having few to no physicians caring for children.1 Many rural and underserved areas depend on family physicians (FPs) for the care of children.In 2006 we reported on the declining proportion of children cared for by and office visits performed by FPs in the United States between 1992 and 2002.2 Using data from a census of the American Board of Family Medicine diplomates who were applying for the board certification examination during the years 2000 through 2009 (n ϭ 7436, 8021, 9223, 9241, 9400, 7794, 8263, 9507, 9692, and 9558, respectively), we provide

PURPOSE The American Board of Family Medicine has completed the 7-year transition of all of its diplomates into Maintenance of Certifi cation (MOC). Participation in this voluntary process must be broad-based and balanced for MOC to have any practical national impact on health care. This study explores family physicians' geographic, demographic, and practice characteristics associated with the variations in MOC participation to examine whether MOC has potential as a viable mechanism for dissemination of information or for altering practice. METHODSTo investigate characteristics associated with differential participation in MOC by family physicians, we performed a cross-sectional comparison of all active family physicians using descriptive and multinomial logistic regression analyses.RESULTS Eighty-fi ve percent of active family physicians in this study (n = 70,323) have current board certifi cation. Ninety-one percent of all active board-certifi ed family physicians eligible for MOC are participating in MOC. Physicians who work in poorer neighborhoods (odds ratio [OR] = 1.105; 95% confi dence interval [CI], 1.038-1.176), who are US-born or foreign-born international medical graduates (OR = 1.444; 95% CI, 1.238-1.684; OR = 1.221; 95% CI, 1.124-1.326, respectively), or who are solo practitioners (OR = 1.460; 95% CI, 1.345-1.585) are more likely to have missed initial MOC requirements than those from a large, undifferentiated reference group of certifi ed family physicians. When age is held constant, female physicians are less likely to miss initial MOC requirements (OR = 0.849; 95% CI, 0.794-0.908). Physicians practicing in rural areas were found to be performing similarly in meeting initial MOC requirements to those in urban areas (OR = 0.966; 95% CI, 0.919-1.015, not signifi cant).CONCLUSION Large numbers of family physicians are participating in MOC. The signifi cant association between practicing in underserved areas and lapsed board certifi cation, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice. INTRODUCTIONM aintenance of Certifi cation (MOC) was approved by the American Board of Medical Specialties (ABMS) in 2000 and adopted by ABMS member boards to promote improvement in the quality of care delivered by certifi ed physicians. The move by ABMS member boards from assessors of competency to agents of quality improvement required a transition from encouraging lifelong learning and performing intermittent recertifi cation to more continuous assessment of professionalism, lifelong learning, cognitive expertise, and performance in practice. This new approach is also an effort to increase public accountability by boards and the physicians they certify. Whether these aims are being met requires regular assessment of the MOC process...

analysis program from the Centers for Disease Control and Prevention. Text coding was performed by 2 authors (MDH, DJI). As no inferential analyses or comparisons were anticipated, the authors conducted no studies of inter-rater consistency. Results are reported as means (SD) and medians for continuous data, and as frequencies for count data.Results: Likert-scale ratings indicated generally favorable responses (predominantly 5 to 6 on a 6-point scale) to the hypertension and diabetes SAMs. In addition, over half (ie, 55% for hypertension and 54% for diabetes participants) of the respondents indicated that the experience would lead to changes in their practices. Navigation and system operation issues predominated in the free-text comments offered for the diabetes and hypertension simulations.

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