Correlates of electronic health record adoption in office practices: a statewide survey

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Introduction

This paper describes the adoption and correlates to adoption of electronic health records in office practices within the state of Massachusetts during the 2005 time period.

Objective

To determine the factors that lead to adoption of EHR in office practices in a single state.

Methods

Eight page mailed survey to a stratified random sample of all office medical practices in the state of Massachusetts. A single physician in each practice was randomly selected to respond. The initial mailing included a $20 dollar cash honorarium. Non responders received additional mailings without additional honoraria and ultimately and astounding response rate of 71% was obtained. The study had 80% power to detect a 10% difference in adoption rates of EHR based on practice type, size, geographic location and hospital affiliation. Because the stratified random sample did not adequately represent all practices within the state, sampling weights were used to more adequately represent the practices.

Results

Forty five percent of the physicians had an EHR which represented 23% of the practices in the state. The use of EHRs varied by practice size with 52% of practices with at least 7 physicians having EHRs. EHRs were also more frequent in hospital based practices and those in teaching institutions. Using logistic regression, the strongest correlate of adoption of EHRs was practice size (OR 3.66 for practices of 7 or more). Other correlates included hospital based practices (OR 2.44) and those associated with teaching (OR 2.3). Not correlated with EHRs were practice type and geographic location. Practices that reported active involvement in quality of care initiatives and those more likely to use email, electronic scheduling and e-prescribing were more likely to have EHRs. The only barrier to EHR adoption reported by at least 50% of the physicians was start up cost.

Comments

The major findings of this study were a higher that expected adoption of EHRs in the state of Massachusetts compared to previous reports in the literature from other areas of the country. In addition, larger hospital based practices associated with teaching were more likely to have adopted EHRs. The findings do not seem too surprising considering the location of the study; a state with several high profile teaching institutions many of which have been on the forefront of the development of EHRs. The use of sampling weights to adjust the data may also have contributed to some of the findings since it is not clear that this technique is an adequate way to adjust for the fact that the sample was biased to large, hospital based practices. Larry Dean