Electronic health records in small physician practices: availability, use, and perceived benefits

Abstract

Objective: To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size.

Design: Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association. Measurements We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care.

Results: With a response rate of 62%, we found that < 2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21-46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13-16%) and statistically significant (p < 0.001). All adopters reported similar benefits. Limitations Although we have adjusted for response bias, influences may still exist.

Conclusion: Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.

Figure 1

(A) Availability of functionality by practice size^*±. ^*Percentage (SE) obtained from logistic regression model adjusting for all variables (other than electronic health record, EHR) in table 1; weighted for the sampling design and non-response. ^±All p values for differences across groups, based on the Wald χ² statistic, are <0.001. (B) Use of functionality most or all of the time by practice size among those who have the functionality^*±. ^*Percentage (SE) obtained from a generalized multinomial logit regression model adjusting for all variables (other than EHR) in table 1; weighted for the sampling design and non-response. ^±p Values are based on the Wald χ² statistic.