Do provider attitudes about electronic health records predict future electronic health record use?

INTRODUCTION: Prior research has shown that provider attitudes about EHRs are associated with successful adoption. There is no evidence on whether comfort with technology and more positive attitudes about EHRs affect use of EHR functions once they are adopted. METHODS: We used data from a survey of providers in the Primary Care Information Project, a bureau of the New York City Department of Health and Mental Hygiene and measures of use from their EHRs. The main predictor variables were scores on three indices: comfort with computers, positive attitudes about EHRs, and negative attitudes about EHRs. The main outcome measures were four measures of use of EHR functions. We used linear regression models to test the association between the three indices and measures of EHR use. RESULTS: The mean comfort with computers score was 2.37 (SD0.53) on a scale of 1-3 with 3 being the most comfortable. The mean positive attitude score was 2.74 (SD 0.40) on a scale of 1-3 with 3 being more positive. The mean negative attitude score was 1.81 (SD 0.54) on a scale of 1-3 with 3 being more negative. Within the first twelve months of having the EHR, 59.5% of visits had allergy information entered into a structured field, 64.8% had medications reviewed, and 74.3% had blood pressured entered. Among visits with a prescription generated, 24.5% had prescriptions electronically. In multivariate regression analysis, we found no significant correlations between comfort with computers, positive attitudes about EHRs, or negative attitudes about EHRs and any of the measures of use. DISCUSSION: Comfort with computers and attitudes about EHRs did not predict future use of the EHR functions. Our findings suggest that meaningful use of the EHR may not be affected by providers' prior attitudes about EHRs.

Does it get easier to use an EHR? Report from an urban regional extension center.

BACKGROUND: Little is known about whether more experience with an electronic health record (EHR) makes it easier for providers to meaningfully use EHRs. OBJECTIVE: To assess whether the length of time that small practice providers have been using the EHR is associated with greater ease in performing meaningful use-related tasks and fewer EHR-related concerns. DESIGN/PARTICIPANTS: We administered a web-based survey to 400 small practice providers in medically underserved communities in New York City participating in an EHR implementation and technical assistance project. We used logistic regression to estimate the association between the length of time a provider had been using the EHR (i.e., "live") and the ease of performing meaningful use-related tasks and EHR-related concerns, controlling for provider and practice characteristics. KEY RESULTS: Compared to providers who had been live 6 to 12 months, providers who had been live 2 years or longer had 2.02 times greater odds of reporting it was easy to e-prescribe new prescriptions (p < 0.05), 2.12 times greater odds of reporting it was easy to e-prescribe renewal prescriptions (p < 0.05), 2.02 times greater odds of reporting that quality measures were easy to report (p < 0.05), 2.64 times greater odds of reporting it was easy to incorporate lab results as structured data (p < 0.001), and 2.00 times greater odds of reporting it was easy to generate patient lists by condition (p < 0.05). Providers who had been live 2 years or longer had 0.40 times lower odds of reporting financial costs were a concern (p < 0.001), 0.46 times lower odds of reporting that productivity loss was a concern (p < 0.05), 0.54 times lower odds of reporting that EHR unreliability was a concern (p < 0.05), and 0.50 times lower odds of reporting that privacy/security was a concern (p < 0.05). CONCLUSIONS: Providers can successfully adjust to the EHR and over time are better able to meaningfully use the EHR.

Patient-centered medical home among small urban practices serving low-income and disadvantaged patients.

PURPOSE: Research on the patient-centered medical home (PCMH) model and practice redesign has not focused on the unique challenges and strengths of very small primary care practices serving disadvantaged patient populations. We analyzed the practice characteristics, prior experiences, and dimensions of the PCMH model that exist in such practices participating in the Primary Care Information Project (PCIP) of the New York City Department of Mental Health and Hygiene. METHODS: We obtained descriptive data, focusing on PCMH, for 94 primary care practices with 5 or fewer clinicians serving high volumes of Medicaid and minority patient populations in New York City. Data included information extracted from PCIP administrative data and survey data collected specifically for this study. RESULTS: Survey results indicated substantial implementation of key aspects of the PCMH among small practices serving disadvantaged patient populations, despite considerable potential challenges to achieving PCMH implementation. Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH. CONCLUSIONS: Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies. The use of flexible, less formal strategies is important to keep in mind when considering implementation and assessment of PCMH-like initiatives in small practices.