Elsevier

The American Journal of Medicine

Volume 127, Issue 10, October 2014, Pages 1010.e21-1010.e27
The American Journal of Medicine

AJM online
Clinical research study
Perceptions of Electronic Health Record Implementation: A Statewide Survey of Physicians in Rhode Island

https://doi.org/10.1016/j.amjmed.2014.06.011Get rights and content

Abstract

Objectives

Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience.

Methods

We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice.

Results

The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction.

Conclusions

We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time.

Section snippets

Study Design

This study has a cross-sectional survey design.

Study Setting and Population

The Rhode Island Department of Health administered the Health Information Technology Survey electronically over the course of 3 weeks in January and February of 2009 to 2013.7 The department used its licensure database to send letters and e-mails (when available) to all licensed physicians providing direct patient care. Participants who did not complete the survey were excluded from these analyses.

Study Measurements

Survey questions included provider and practice

Results

The survey response rate was 62% in 2013, with 2365 of 3799 physicians completing surveys. Most doctors work more than 20 hours per week, have Doctor of Medicine degrees, have their primary practice in an office, are primary care providers, and work in groups of more than 10 providers (Table 1). There are differences between respondents with and without an electronic health record. Respondents with an electronic health record are likely to have larger populations of patients with Medicaid

Discussion

We present the most comprehensive assessment of statewide physician electronic health record use to date, documenting how electronic health record adoption has increased among all licensed providers in Rhode Island from 2009 to 2013.9, 10 By using 2013 data, we identified physician and practice traits associated with electronic health record adoption, including younger age, more patients with Medicaid insurance, hospital practice, practice in larger groups, and primary care practice. We also

Conclusions

We estimate that 81% of Rhode Island physicians are now using an electronic health record of some description. Surgical subspecialists and psychiatrists are less likely to use an electronic health record, so adoption in the remaining providers may be improved by better tailoring to these providers. We also find that although most providers find their job satisfaction decreases with electronic health record introduction, there is evidence that longer duration of use and improvement in electronic

Acknowledgments

The annual Health Information Technology Survey is funded by the State of Rhode Island's Healthcare Quality Reporting Program. The survey is jointly administered by the Rhode Island Department of Health and its public reporting contractor, Healthcentric Advisors, whose work is appreciated. This article was written as part of the Quality Improvement class at the School of Public Health at Brown University. The authors acknowledge the invaluable input of the class and instructor Dr Amal Trivedi,

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  • Cited by (0)

    Funding: MCW work is supported by an educational stipend from the University Emergency Medical Foundation.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing this manuscript.

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