Prevalence of basic information technology use by U.S. physicians

Abstract

Background: Information technology (IT) has been advocated as an important means to improve the practice of clinical medicine.

Objectives: To determine current prevalence of non-electronic health record (EHR) IT use by a national sample of U.S. physicians, and to identify associated physician, practice, and patient panel characteristics.

Design, setting, and participants: Survey conducted in early 2004 of 1,662 U.S. physicians engaged in direct patient care selected from 3 primary care specialties (family practice, internal medicine, pediatrics) and 3 nonprimary care specialties (anesthesiology, general surgery, cardiology).

Measurements: Self-reported frequency of e-mail communication with patients or other clinicians, online access to continuing medical education or professional journals, and use of any computerized decision support (CDS) during clinical care. Survey results were weighted by specialty and linked via practice zip codes to measures of area income and urbanization.

Results: Response rate was 52.5%. Respondents spent 49 (+/-19) (mean [+/-standard deviation]) hours per week in direct patient care and graduated from medical school 23 (+/-11) years earlier. "Frequent" use was highest for CDS (40.8%) and online professional journal access (39.0%), and lowest for e-mail communication with patients (3.4%). Ten percent of physicians never used any of the 5 IT tools. In separate logistic regression analyses predicting usage of each of the 5 IT tools, the strongest associations with IT use were primary care practice (adjusted odds ratios [aORs] ranging from 1.34 to 2.26) and academic practice setting (aORs 2.17 to 5.41). Years since medical school graduation (aOR 0.85 to 0.87 for every 5 years after graduation) and solo/2-person practice setting (aORs 0.21 to 0.55) were negatively associated with IT use. Practice location and patient panel characteristics were not independently associated with IT use.

Conclusions: In early 2004, the majority of physicians did not regularly use basic, inexpensive, and widely available IT tools in clinical practice. Efforts to increase the use of IT in medicine should focus on practice-level barriers to adoption.

FIGURE 1

Odds ratios for frequent use of at least 3 of 5 information technology (IT) tools (e-mail with patients, e-mail with other clinicians, online continuing medical education, online professional journal access, and real-time use of computerized clinical decision support). Odds adjusted for physician gender, years since medical school graduation, hours in direct patient care/week, and site of medical school graduation; practice type, poverty level and degree of urbanization of practice county; and percentage of patients insured by Medicaid or primary language not English; specialty training, specialist (anesthesia, cardiology, general surgery) versus primary care specialties (family practice, internal medicine, pediatrics).