Electronic medical record use by office-based physicians and their practices: United States, 2006
EMR usage continues to grow exponentially, but not in comprehensiveness or evenly across all physician populations
Hing ES, Burt CW, Woodwell DA. Electronic Medical Record Use by Office-Based Physicians and Their Practices: United States, 2006. Adv Data. 2007; 393:1-8.
What is the current state of adoption of electronic medical records in 2006 and what are the trends since 2001?
Physician induction interviews of the National Ambulatory Medical Care Survey (NAMCS) in 2006 compared to previous historic study data since 2001.
Study selection and assessment
2,117 responding and eligible of a 3,350 sample of non-federal office-based physicians in all 50 states and D.C. from a total of 112 geographic primary sampling units. Compound sampling weights were used to produce a national estimate and calculate sampling error. Estimates of practice usage were calculated using a multiplicity estimator. Differences were calculated using statistical testing (chi-square tests, Student’s t, or weighted linear regression) with significance at p< 0.05. 1,311 physicians who completed their NAMCS assigned week’s sampling were interviewed with an unweighted response rate of 61.9% (63.6% weighted). Physicians who answered “yes” to the question on whether they had an EMR were asked seven additional questions to gauge the comprehensiveness and features of their system. The definition of a “comprehensive” EMR was obtained from an expert group. It was defined as electronic prescription/test ordering, reporting of imaging/lab results, and clinical notes. Additional questions as to availability of public health reporting, reminders as to guidelines/screening, and whether they had turned off part of their available EMR features were asked. The sample group was stratified by age, gender, specialty, practice size, number of managed care contracts, and geographic region as to EMR usage.
“Yes” or other response to interview questions during face to face interviews.
EMR use increased with practice size and urban location, was unaffected by specialty or gender, and decreased with age of the physician. EMR use was higher in HMOs and varied by number of managed care contracts, though not linearly. The West was the highest user (42.3%) of any EMR followed, in order of percent adoption, by the Midwest, South, and Northeast. EMR use of any type increased 22% since 2005 and 60% since 2001. This was statistically significant but there was no statistically significant difference in the adoption of “comprehensive” EMR in that time period. Other findings were that among physicians with fully electronic records only 6.6% had electronic public health reporting, 2.3% turn off some feature in their EMR, 52.9% had electronic prescribing, 46.5% could order tests electronically, and 63.7% had a reminder system for guidelines/screening. Finally, 23.9 % planned to buy or replace an EMR in the next 3 years and 14.9% were thinking about it.
EMR usage of some type continues to increase exponentially. However, comprehensive, full-featured EMRs are not increasing by a statistically significant rate. The most likely users are young, urban physicians in managed care organizations in the West of any gender or specialty.
Thomas A. Carr