EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption

Jamoom, Eric; Patel, Vaishali; Furukawa, Michael F.; King, Jennifer

doi:10.1016/j.hjdsi.2013.12.004

Cited by 56 publications

(45 citation statements)

References 15 publications

(20 reference statements)

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“…Moreover, ambulatory care in the German language region is increasingly characterized by the formation of medical networks that goes along with a higher demand for information exchange among healthcare Previous studies in this field suggested that health IT adoption is also associated with age and sex [5,14,16,29,[49][50][51]. Our results suggest that young age (30−39 years) and male sex are predictors of EHR adoption but have only limited impact on the adoption of the surveyed electronic workflows supporting health data exchange.…”

Section: Discussionmentioning

confidence: 60%

“…Another objective of our study was to investigate the effect of physicians' attitude towards health IT on health IT adoption, use of electronic workflow practices and the intention to expand individual health IT use in the future, because a lot of qualitative studies suggested that there exists an association [5,14,16,29,[31][32][33][34][35][36]. Indeed, it emerged that physicians' attitude towards health IT was an independent predictor on most outcomes (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…We designed the respective items according to literature indicating that the concepts underlying these items reflect important motivational forces (e.g. healthcare providers' (dis-)satisfaction with the status quo, perceived ease of use, perceived usefulness) and socio-technical factors that can facilitate or limit the adoption of health IT in healthcare professionals [5,14,16,29,[31][32][33][34][35][36][37][38][39]. …”

Section: Questionnairementioning

confidence: 99%

“…This led policy makers to base national eHealth strategies largely on measures to accelerate the adoption of EHR systems [8][9][10][11]. Especially studies on barriers to the acceptance of eHealth and frameworks for the assessment of eHealth readiness tend to focus particularly on healthcare providers' views of EHRs [7,[12][13][14][15][16]. The problem is, however, that this approach neglects the great variety of EHR definitions and potentially available EHR functionalities.…”

Section: Introductionmentioning

confidence: 99%

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Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

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BACKGROUND: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. OBJECTIVE: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows. METHODS: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score. RESULTS: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger. CONCLUSION: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. Abstract BackgroundThe adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. ObjectiveWe aim to assess the proportion of physicians who are routinely working with electronic health dataand describe to what extent physicians exchange electronic health data with peers and other health care p...

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Questionnairementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

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“…27 We need to continue to track and understand the factors holding nonadopters back so that the next generation of policies can be designed to result in universal use of EHR systems.…”

Section: Policy Implicationsmentioning

confidence: 99%

Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings

et al. 2014

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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.

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Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus

Walunas

Jackson

Chung

et al. 2017

Arthritis Care & Research

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Objective To examine the impact of care fragmentation across multiple healthcare institutions on disease outcomes in patients with systemic lupus erythematosus (SLE). Methods Using the Chicago HealthLNK Data Repository (HDR), an assembly of electronic health records from six institutions, we identified patients with SLE, using ICD-9 codes, whose care was delivered at more than one organization. We examined whether patients had severe infections or comorbidities (ICD-9 code defined) that indicate SLE-induced damage. T-tests and chi-squared tests were used to examine differences between fragmentation groups. Logistic regression was used to assess factors contributing to the occurrence of disease outcomes. Results We identified 4,276 patients with SLE. 856 (20%) received care from more than one healthcare institution. African American patients and patients with public insurance were more likely to experience care fragmentation compared to white and private insurance patients (OR 1.66; 95% CI 1.44, 1.97 and OR 1.63; 95% CI 1.42, 1.95). We identified increased risk of infections (OR 1.57; 95% CI 1.30, 1.88), cardiovascular disease (OR 1.51; 95% CI 1.23, 1.86), end stage renal disease (OR 1.34; 95% CI 1.05, 1.70), nephritis (OR 1.28; 95% CI 1.07, 1.54) and stroke (OR 1.28; 95% CI 1.01, 1.62) among patients with fragmented care, adjusted for age, sex, race, insurance status, length of follow-up time, and total visit count. Conclusion In this cross-site cohort of SLE patients, care fragmentation is associated with increased risk of severe infection and comorbidities. These results suggest that improved health information exchange could positively impact outcomes for SLE patients.

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EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption

Cited by 56 publications

References 15 publications

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings

Disease Outcomes and Care Fragmentation Among Patients With Systemic Lupus Erythematosus

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