Physician adoption of electronic health records: a visualisation of the role of provider and state characteristics in incentive programme participation

摘要

The United States has been lagging behind other developed nations in electronic health record implementation. To encourage electronic health record adoption, in 2011, the Centers for Medicare & Medicaid Services created meaningful use and incentive programmes which offer providers and hospitals financial incentives for meeting certain guidelines and adopting the electronic health record. The objective of the study was to analyse the role of provider and state characteristics in provider time of adoption of the electronic health record. We started with the Centers for Medicare & Medicaid public use file of payments to providers from 2011 through 2014 (N = 523,371). We merged the preceding with publicly available databases consisting of the provider's specialty and the characteristics of the state within which the provider practices--chronic disease rate, urban area percentage, median income, median age, minority percentage and political affiliation. Additionally, we collected publicly available provider age data for a subset in our database. We produced visual analytics in Tableau, a visualisation software, to represent the impact of provider and state characteristics. Family medicine physicians and internists were the most active in all stages of adoption. Providers in their forties and fifties were earlier in adoption of the electronic health record. Providers in blue states, whose political affiliation is democratic, were ahead in electronic health record implementation. Providers in states with higher median income and age were also earlier. The impact of chronic disease rate and minority percentage was in the opposite direction. Later adopters of the electronic health record were in states with higher chronic disease rate (that is, three out of four chronic disease rates studied) and higher minority populations. Regional Extension Centers are instrumental within states in supporting providers in their adoption of health information technology. Utilising better strategies focusing on timing and diffusion of new health information technology to underprivileged areas can improve healthcare and reduce inequities in patient care.