SummaryObjective: Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored. Methods: We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree). Results: Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine / general practitioners. After adjustment for covariates, these specialties were 44 -94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty. Conclusions: Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties.
BackgroundThe United States (U.S.) federal government has committed more than $20 billion to encourage physicians to adopt electronic health records (EHRs) [8]. Driving these incentives is the expectation that large scale appropriate use of EHRs will facilitate coordination of care, improve health care quality, and lower national health care costs [5,9]. To receive incentive payments, physicians must purchase and install a certified EHR, then demonstrate "meaningful use" by meeting specific criteria. Example criteria include use of software to reduce medical errors (i.e. electronic prescribing), collection of data relevant for clinical quality measurement (i.e. smoking status), and maintenance of patient summaries to facilitate sharing of data among providers (i.e. electronic problem lists and medication lists) [10].Several previous initiatives, such as national recognition programs for the Patient-Centered Medical Home, have encouraged adoption of EHRs among primary care physicians [17]. Many of the most common quality measures, including those for EHRs, also focus on primary care [24]. However, there is an increasing effort to facilitate electronic exchange of clinical data across providers caring for commo...