Physician Specialty and Variations in Adoption of Electronic Health Records

Abstract

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...

Psychiatrists’ Comfort Using Computers and Other Electronic Devices in Clinical Practice

“…This finding supports other observations of lower rates of health IT adoption by psychiatrists compared to primary care and other medical specialists [6–10]. Indeed, even after accounting for practice type, geographic region and other physician characteristics, outpatient psychiatrists had a lower likelihood of adopting an EHR than ambulatory physicians in any other specialty [7].…”

“…In addition, psychiatrists lag behind other specialties in adoption of information technologies [6–10]. This is particularly true for psychiatrists who practice in small group or solo practice settings [11].…”

“…This is particularly true for psychiatrists who practice in small group or solo practice settings [11]. The slower pace of adoption among psychiatrists may relate to a poor fit or usability of EHR systems for psychiatric practice, minimal IT support for psychiatrists in small group or solo practice settings, limited training or experience with computers, concerns about confidentiality of patient data, and computer use interference with therapeutic alliance during clinical encounter [5, 6, 10–14]. …”

Electronic health record impact on productivity and efficiency in an academic pediatric ophthalmology practice

“…Such variation in response to EHRs is commonly reported in the literature, and some proposed explanations have included differences in physician characteristics, such as intention to use and perceptions about the value of the EHR system, age, medical specialty, and previous computer experience. 29,30 The current study was not designed to identify reasons for variations among providers because of the small division size. This question warrants further investigation to identify potential opportunities for improving the utilization of EHR systems.…”

The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

“…Recent estimates indicate that nearly 95% of hospitals and almost 62% of cardiology practices have an EHR. [9][10][11] Second, EHR data have the potential to provide much more detail on patient-level encounters than administrative claims or other data sources. 12 Third, the immediate availability of data possible with EHRs allows its real-time use in clinical care, enabling point-of-care CDS, patient safety alerts, and patient risk estimation.…”