Social networks and physician adoption of electronic health records: insights from an empirical study

Abstract

Objective: To study how social interactions influence physician adoption of an electronic health records (EHR) system.

Design: A social network survey was used to delineate the structure of social interactions among 40 residents and 15 attending physicians in an ambulatory primary care practice. Social network analysis was then applied to relate the interaction structures to individual physicians' utilization rates of an EHR system.

Measurements: The social network survey assessed three distinct types of interaction structures: professional network based on consultation on patient care-related matters; friendship network based on personal intimacy; and perceived influence network based on a person's perception of how other people have affected her intention to adopt the EHR system. EHR utilization rates were measured as the proportion of patient visits in which sentinel use events consisting of patient data documentation or retrieval activities were recorded. The usage data were collected over a time period of 14 months from computer-recorded audit trail logs.

Results: Neither the professional nor the perceived influence network is correlated with EHR usage. The structure of the friendship network significantly influenced individual physicians' adoption of the EHR system. Residents who occupied similar social positions in the friendship network shared similar EHR utilization rates (p<0.05). In other words, residents who had personal friends in common tended to develop comparable levels of EHR adoption. This effect is particularly prominent when the mutual personal friends of these 'socially similar' residents were attending physicians (p<0.001).

Conclusions: Social influence affecting physician adoption of EHR seems to be predominantly conveyed through interactions with personal friends rather than interactions in professional settings.

Figure 1

Illustration of common social contagion mechanisms.

Figure 2

Sociograms of the three social networks delineated. Circles, resident physicians; Squares, attending physicians; Blue (darker) shades, areas enclosed by the active participants of the study (the second- and third-year residents); Green (lighter) shades, areas enclosed by the attending physicians. The size of a node is proportional to its eigenvector centrality. Better connected nodes are larger.