Use of Health Information Technology by Office-based Physicians: Comparison of Two Contemporaneous Public-Use Physician Surveys

摘要

This study exploited the unique opportunity to compare estimates of electronic health record (EHR) and specific health information technology (HIT) use for clinical activities by office-based physicians using data from two contemporaneous, nationally representative physician surveys: the 2008 National Ambulatory Medical Care Survey (NAMCS) and the 2008 Health Tracking Physician Survey (HTPS). Survey respondents included 4,117 physicians from the HTPS and 1,187 physicians from the NAMCS. We compared the survey designs and national estimates of EHR and specific HIT use for clinical activities in the two surveys and conducted multivariate analyses examining physician and practice characteristics associated with the adoption of “basic” or “fully functional” systems. The surveys asked nearly identical questions on EHR use.Questions on specific HIT use for clinical activities overlapped but with differences. National estimates of all-EHR use were similar (HTPS 24.31 percent, 95 percent confidence interval [CI]: 22.99–25.69 percent vs. NAMCS 27.24 percent, 95 percent CI: 23.53–31.29 percent), but partial EHR use (i.e., part paper and part electronic) was higher in the HTPS than in the NAMCS (23.93 percent, 95 percent CI: 22.61–25.30 percent vs. 18.40 percent, 95 percent CI: 15.62–21.54 percent in the NAMCS). Both surveys reported low use of “fully functional” systems (HTPS 7.84 percent, 95 percent CI: 7.03–8.73 percent vs. NAMCS 4.56 percent, 95 percent CI 3.09–6.68 percent), but the use of “basic” systems was much higher in the HTPS than in the NAMCS (22.29 percent vs. 11.16 percent). Using multivariate analyses, we found common physician or practice characteristics in the two surveys, although the magnitude of the estimated effects differed. In conclusion, use of a “fully functional” EHR system by office-based physicians was low in both surveys. It may be a daunting task for physicians, particularly those in small practices, to adopt and achieve “meaningful use” in the next two years. Key words: health information technology, electronic health records, physician surveyIntroductionHealth information technology (HIT) is “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.”~(1) HIT such as electronic health records (EHRs, also called electronic medical records) has the potential to improve the quality and safety of care received by patients.~(2)~(–)~(4) However, the adoption of EHRs, particularly those that meet the criteria of a fully functional system, has been slow among office-based physicians.~(5) To encourage adoption, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009, authorizing up to $27 billion in total funding to support widespread adoption of EHRs by physicians and hospitals through incentive payments from Medicare and Medicaid programs.~(6)Two large, nationally representative public-use physician surveys have been used to track adoption of EHRs among physicians. One is the National Ambulatory Medical Care Survey (NAMCS), conducted annually by the Centers for Disease Control and Prevention (CDC). Since 2005, the public-use data files have included information on HIT use (including EHRs) in physicians' offices. The latest available for public use is the 2008 survey. The other survey is the Community Tracking Study (CTS) Physician Survey, conducted by the Center for Studying Health System Change and sponsored by the Robert Wood Johnson Foundation. The CTS physician surveys have been conducted in 1996–1997, 1998–1999, 2000–2001, 2004–2005, and 2008. Information on HIT use was included since the 2004–2005 survey. The 2008 survey, renamed the Health Tracking Physician Survey (HTPS) because of survey design changes, contains information on HIT use (including EHRs), which provides a unique opportunity for comparison with the NAMCS. The HTPS surveyed more than four times as many physicians as the 2008 NAMCS and thus can provide more precise estimates.This study exploits the unique opportunity to estimate the use of HIT by office-based physicians using data from the two contemporaneous, nationally representative physician surveys: the 2008 NAMCS and 2008 HTPS. To the best of our knowledge, these are the only two such surveys that are conducted periodically and available for public use. The NAMCS and HTPS have considerable overlap in information regarding HIT use, but there are important differences in sampling schemes and survey items regarding HIT use for clinical activities. While recent studies have examined the NAMCS data and others used CTS physician surveys, no studies have compared data from both.~(7)~(–)~(14)This comparison presents a unique opportunity to examine the robustness in national estimates of HIT adoption. Moreover, although similar information on HIT use was collecte