Medical groups' adoption of electronic health records and information systems

Health Affairs

Volumn 24, Issue 5, 2005, Pages 1323-1333

  Gans, David ^a   Kralewski, John ^b   Hammons, Terry ^c   Dowd, Bryan ^d  

^a MEDICAL GROUP MANAGEMENT ASSOCIATION   (United States)

^b UNIVERSITY OF MINNESOTA   (United States)

^c MGMA ^*  (United States)

^d UNIVERSITY OF MINNESOTA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; INFORMATION PROCESSING; INFORMATION SYSTEM; MANAGEMENT; MASS COMMUNICATION; MEDICAL RECORD; UNITED STATES; UTILIZATION REVIEW;

DATA COLLECTION; DIFFUSION OF INNOVATION; INFORMATION SYSTEMS; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; PRACTICE MANAGEMENT, MEDICAL; UNITED STATES;

EID: 27644518415     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.24.5.1323     Document Type: Article

References (33)

1. For a synthesis of a number of studies, see D.J. Brailer and E.L. Terasawa, "Use and Adoption of Computer-based Patient Records," October 2003, www.chcf.org/topics/view.cfm?itemID=21525 (29 July 2005);
2. and R.H. Miller and I. Sim, "Physicians' Use of Electronic Medical Records: Barriers and Solutions," Health Affairs 23, no. 2 (2004): 116-126.
3. See also A.M. Audet et al. "Information Technologies: When Will They Make It into Physicians' Black Bags?" Medscape General Medicine 6, no. 4 (2004), www.medscape.com/viewarticle/493210 (28 June 2005; registration required);
4. N.F. Piland et al., The Current Status of Electronic Medical Record and Practice Automation Systems in Medical Group Practices, Second Annual Report (Englewood, Colo.: Medical Group Management Association Center for Research, December 2002);
5. and R.H. Miller, J.M. Hillman, and R.S. Given, "Physician Use of IT: Results from the Deloitte Research Survey," Journal of Healthcare Information Management 18, no. 1 (2004): 72-80. Brailer and Terasawa point out that the estimates of EHR use vary among different studies for a variety of reasons, including the characteristics of the particular practices surveyed. We report percentages of practices that have EHRs rather than percentages of physicians; the latter would be higher than the former because large practices are more likely than small practices to have EHRs.
6. J.C. Martin, et al., "The Future of Family Medicine: A Collaborative Project of the Family Medicine Community," Annals of Family Medicine 2, Supp. 1 (2004): S3-S32.
7. For a recent review of pay-for-performance programs, see M.B. Rosenthal et al., "Paying for Quality: Providers' Incentives for Quality Improvement," Health Affairs 23, no. 2 (2004): 127-141.
8. See Brailer and Terasawa, "Use and Adoption of Computer-based Patient Records";
9. Miller and Sim, "Physicians' Use of Electronic Medical Records";
10. Audet et al., "Information Technologies";
11. and Piland et al., The Current Status.
12. Regarding reasons for slow adoption, see C.J. McDonald, "The Barriers to Electronic Medical Record Systems and How to Overcome Them," Journal of the American Medical Informatics Association 4, no. 3 (1997): 213-221;
13. Miller and Sim, "Physicians' Use of Electronic Medical Records";
14. Piland et al., The Current Status;
15. K. MacDonald, J. Metzger, and M. Mann, "Achieving Tangible IT Benefits in Small Physician Practices," September 2002, www.chcf.org/topics/view.cfm?itemID=19898 (29 July 2005);
16. and R.H. Miller, I. Sim, and J. Newman, "Electronic Medical Records: Lessons from Small Physician Practices," October 2003, www.chcf.org/topics/view.cfm?itemID=21521 (29 July 2005).
17. Audet et al., "Information Technologies";
18. Brailer and Terasawa, "Use and Adoption";
19. and L. Landro, "Doctors Say Office Technology Is Costly and Cumbersome,"Wall Street Journal, 27 July 2003.
20. For examples of implementation, see S. Barlow, J. Johnson, and J. Steck, "The Economic Effect of Implementing an EMR in an Outpatient Clinical Setting," Journal of Healthcare Information Management 18, no. 1 (2004): 46-51;
21. and Miller et al., "Electronic Medical Records."
22. The cost-benefit analysis is in S.J. Wang et al., "A Cost-Benefit Analysis of Electronic Medical Records in Primary Care," American Journal of Medicine 114, no. 5 (2003): 397-403.
23. This group practice database is being assembled from multiple sources, including members and other contacts in the MGMA database, commercial databases, several professional associations including the American Medical Association, and others under a contract from AHRQ to the University of Minnesota and the MGMA Center for Research. The total number of U.S. group practices is not known, but we estimate it to be somewhat larger than the 34,490 practices we identified, perhaps in the range of 40,000-50,000. Fewer than one-third of the practices are MGMA members.
24. The instruments used can be viewed at Medical Group Management Association Center for Research, www.mgma.com/research/loader.cfm?url=/ commonspot/security/getfile.cfm&PageID=152 (29 July 2005).
25. If there is a nonresponse bias in the Web and mail survey data (and therefore in the combined data), it is likely to result in a small (1-2 percent) overestimate of the fraction of practices with EHRs, and it is more likely to affect estimates for the smaller practices. This would be consistent with practices without EHRs being less interested in EHRs and less likely to respond to the Web and mail surveys.
26. Because there are many more small practices in the United States than large ones, even after we oversampled larger practices, the 3,629 practices responding broke into categories of 47.8 percent with five or fewer physicians, 24.3 percent with six to ten physicians, 13.3 percent with eleven to twenty physicians, and 14.6 percent practices with twenty-one or more physicians.
27. The definition of EHR in the survey was chosen in consultation with staff at AHRQ with intent to make clear that items in the EHR are searchable and retrievable. We assumed that this definition would be familiar to most practice administrators; we did not encounter any confusion expressed in comments on returned surveys or in our interviews. See Note 8.
28. For example, see Audet et al., "Information Technologies." Audet and colleagues also found that use of EHRs in solo physician practices is lower than in practices with two to nine physicians.
29. We observed variation by specialty type (multispecialty versus single specialty and particular specialties represented), by type of ownership, and by relationship to academic institutions (data not shown). The effects of these factors are generally smaller than that of size of practice, and they interact with each other and with size of practice and other variables; they will be analyzed using multivariate models (results not reported here). Variation by region was relatively small.
30. This survey was conducted confidentially (rather than anonymously), and contact information was collected for most respondents, enabling follow-up surveys of responding practices.
31. The remaining analyses rely on responses to the Web and mail surveys because these questions were not asked on the shorter telephone survey. By extension from the answers to the questions common to all the surveys, we think that any nonresponse bias is small and that nonrespondents would, if different from respondents, be slightly less positive about the benefits of EHRs.
32. The Doctors Office Quality Information Technology (DOQ-IT) program will provide support to small and medium-size practices selecting and implementing EHRs. For more information, see www.doqit.org.
33. It is likely that most practices, regardless of their commitment to becoming wholly computerized or "paperless," will for some time have to interact with some pharmacies, consultants, and diagnostic testing sources by nonelectronic means. For example, some radiology groups may be able neither to receive requests for studies nor to report the results electronically.