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. 2013 May 22;4(2):225-40.
doi: 10.4338/ACI-2013-02-RA-0015. Print 2013.

Physician specialty and variations in adoption of electronic health records

Z M Grinspan  1 , S Banerjee, R Kaushal, L M Kern
Affiliations

Physician specialty and variations in adoption of electronic health records

Z M Grinspan et al. Appl Clin Inform. .

Abstract

Objective: Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored.

Methods: We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree).

Results: Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine/general practitioners. After adjustment for covariates, these specialties were 44-94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty.

Conclusions: Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties.

Keywords: Electronic health records; United States; ambulatory care; health policy; specialization.

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Figures

Fig. 1
Fig. 1
Prevalence of EHR Adoption Among US Ambulatory Physicians, by Specialty, 2009. Empty symbols indicate the prevalence is lower than the smallest reliable estimate determined by the National Center for Health Statistics. Vertical lines illustrate average adoption for any EHR (dashed), basic EHR (dotted), and full EHR (dot-dash). Percentages have been adjusted for survey weights. Error bars indicate 1 SE.
Fig. 2
Fig. 2
Prevalence of EHR Adoption Among US Ambulatory Physicians, by Specialty, 2005–2009. Any EHR adoption data reflects the years 2005 – 2009, basic and full EHR adoption data reflect the years 2007–2009. Error bars are suppressed for readability. Percentages have been adjusted for survey weights.
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References

    1. National Ambulatory Medical Care Survey, 2005Codebook. Ann Arbor, Michigan: Inter-University Consortium for Political and Social Research; 2005
    1. National Ambulatory Medical Care Survey, 2006User Guide. Ann Arbor, Michigan: Inter-University Consortium for Political and Social Research; 2006
    1. National Ambulatory Medical Care Survey, 2007User Guide. Ann Arbor, Michigan: Inter-University Consortium for Political and Social Research; 2007
    1. National Ambulatory Medical Care Survey, 2008User Guide. Ann Arbor, Michigan: Inter-University Consortium for Political and Social Research; 2008
    1. Health Information Technology for Economic and Clinical Health Act. waysandmeans.house.gov/media/pdf/111/hitech.pdf (19 April 2012).

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