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Multicenter Study
. 2018 Feb 1;136(2):164-170.
doi: 10.1001/jamaophthalmol.2017.5978.

Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States

Michele C Lim  1 , Michael V Boland  2   3   4 , Colin A McCannel  5 , Arvind Saini  6 , Michael F Chiang  7 , K David Epley  8 , Flora Lum  9
Affiliations
Multicenter Study

Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States

Michele C Lim et al. JAMA Ophthalmol. .

Abstract

Importance: Assessing the rate of electronic health record (EHR) adoption and ophthalmologists' perceptions on financial and clinical productivity is important in understanding how to direct future design and health care policy.

Objective: To assess adoption rate and perceptions of financial and clinical outcomes of EHRs among ophthalmologists in the United States.

Design, setting, and participants: Population-based, cross-sectional study. A random sample of 2000 ophthalmologists was generated on the basis of mailing address zip codes from the 2015 American Academy of Ophthalmology US active membership database, which included more than 18 000 ophthalmologists. A survey was sent by email to assess adoption rate of EHRs, perceptions of financial and clinical productivity, and engagement with Medicare and Medicaid programs that incentivize the use of EHRs. The survey was conducted between 2015 and 2016.

Main outcomes and measures: Adoption rate of EHRs and perceptions of financial and clinical productivity.

Results: The adoption rate of EHRs among surveyed ophthalmologists (348 respondents) was 72.1%. The responding ophthalmologists perceived that their net revenues and productivity have declined and that practice costs are higher with EHR use. Of those who attested for stage 1 of the EHR incentive program, 83% had already or were planning to attest to stage 2, but 9% had no plans.

Conclusions and relevance: The adoption of EHRs by ophthalmologists has more than doubled since a 2011 survey and is similar to that of primary care physicians (79%). In comparison with 2 previous surveys of ophthalmologists, respondents had more negative perceptions of EHR productivity outcomes and effect on practice costs, although financial data were not collected in this survey to support these opinions. These negative perceptions suggest that more attention should be placed on improving the efficiency and usability of EHR systems.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Chiang reports grants from the National Institutes of Health (EY19474, EY22387, and EY10572), National Science Foundation (1622679), and Research to Prevent Blindness. He is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems and Consultant on the Steering Committee member for RAINBOW study at Novartis. Dr Boland reports research support from Alcon Labs. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Electronic Health Record Implementation Status by Year of Survey
Figure 2.
Figure 2.. Perception of Productivity Changes (Number of Patients Seen per Day) After Electronic Health Record (EHR) Adoption
Perception of productivity changes (number of patients seen per day) after EHR adoption from the 2006 and 2011 ophthalmology surveys and in the current 2016 survey.
Figure 3.
Figure 3.. Perception of Change in Overall Practice Costs After Electronic Health Record (EHR) Adoption
Perception of change in overall practice costs after EHR adoption from the 2006 and 2011 ophthalmology surveys and in the 2016 survey.
See this image and copyright information in PMC

Comment in

  • Electronic Health Records Are Here to Stay.
    Weizer JS, Ehrlich JR, Lee PP. Weizer JS, et al. JAMA Ophthalmol. 2018 Feb 1;136(2):170-171. doi: 10.1001/jamaophthalmol.2017.5918. JAMA Ophthalmol. 2018. PMID: 29285532 No abstract available.

References

    1. Chiang MF, Boland MV, Margolis JW, Lum F, Abramoff MD, Hildebrand PL; American Academy of Ophthalmology Medical Information Technology Committee . Adoption and perceptions of electronic health record systems by ophthalmologists: an American Academy of Ophthalmology survey. Ophthalmology. 2008;115(9):1591-1597. - PubMed
    1. Hsiao CJ, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2012. NCHS Data Brief. 2012;(111):1-8. - PubMed
    1. Hsiao C-J, Jha AK, King J, Patel V, Furukawa MF, Mostashari F. Office-based physicians are responding to incentives and assistance by adopting and using electronic health records. Health Aff (Millwood). 2013;32(8):1470-1477. - PubMed
    1. Boland MV, Chiang MF, Lim MC, et al. ; American Academy of Ophthalmology Medical Information Technology Committee . Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey. Ophthalmology. 2013;120(8):1702-1710. - PubMed
    1. CMS Medicare and Medicaid EHR Incentive Program; Office of the National Coordinator for Health Information Technology, Department of Health and Human Services. Electronic health record products used for attestation. https://catalog.data.gov/dataset/cms-medicare-and-medicaid-ehr-incentive.... Published 2017. Accessed November 1, 2017.

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