Nir Menachemi

Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?

OBJECTIVESnThe purpose of this study was threefold. First, we gathered and synthesized the historic literature regarding electronic health record (EHR) adoption rates among physicians in small practices (ten or fewer members). Next, we constructed models to project estimated future EHR adoption trends and timelines. We then determined the likelihood of achieving universal EHR adoption in the near future and articulate how barriers can be overcome in the small and solo practice medical environment.nnnDESIGNnThis study used EHR adoption data from six previous surveys of small practices to estimate historic market penetration rates. Applying technology diffusion theory, three future adoption scenarios, optimistic, best estimate, and conservative, are empirically derived.nnnMEASUREMENTnEHR adoption parameters, external and internal coefficients of influence, are estimated using Bass diffusion models.nnnRESULTSnAll three EHR scenarios display the characteristic diffusion S curve that is indicative that the technology is likely to achieve significant market penetration, given enough time. Under current conditions, EHR adoption will reach its maximum market share in 2024 in the small practice setting.nnnCONCLUSIONnThe promise of improved care quality and cost control has prompted a call for universal EHR adoption by 2014. The EHR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers.

Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies

In the current paper, we describe the challenges in measuring return on investment (ROI) and review published ROI studies on health IT. In addition, given the absence of a robust ROI literature base, we review the general benefits and potential costs of various health IT applications including electronic health records (EHRs), computerized physicians order entry (CPOE) systems, and clinical decision support systems (CDSS). We conclude that articles examining these benefits are much more common than studies examining ROI itself. This trend suggests the early stage of this knowledge base. Additional research utilizing broader perspectives and multidisciplinary techniques will be needed before a better understanding of ROI from health IT is achieved.

Factors Affecting the Adoption of Telemedicine—A Multiple Adopter Perspective

This paper utilizes the diffusion of innovation framework to discuss factors affecting adoption of telemedicine. Empirical and anecdotal findings are organized across five attributes affecting innovation adoption rates for the following four adopter groups: physicians, patients, hospital administrators, and payers. A discussion of the implications is included.

Opening the black box: measuring hospital information technology capability.

Abstract: Recently, health care investment in information technology (IT) has experienced a significant increase. Paralleling this increase has been an increase in IT capabilities. Despite the interest in and promises of IT in the health care setting, there is a paucity of empirical research that has attempted to define an organizational measure of IT capability. The dearth of research has contributed to the traditional belief that IT is perceived as a black box, whereby organizational resources enter the box as inputs and are somehow transformed into positive outcomes for an organization. However, for positive outcomes to be realized, these outcomes must be measurable. This research uses a stakeholder perspective to develop a theoretically specified measure of IT capability. A latent construct, IT munificence, is proposed using tenets from diffusion of innovation theory and strategic contingency theory. The construct is tested using a sample of 1,545 acute care hospitals located in the United States. IT munificence fits the study data well, supporting the hypothesis that IT munificence represents a strategy of hospital IT capability.

Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions

Many functions important to realizing the full potential from electronic health records (EHRs) may not be selected by all physicians using EHRs in the ambulatory setting. This article examines the extent to which EHR systems used by Florida physicians include functionalities that the Institute of Medicine has designated as being critical for optimal performance. Results indicate that EHR systems used by recent adopters, when compared with early adopters, appear to be missing key patient safety and cost control functions. Overall, many physicians are only partially adopting EHR technologies, suggesting that published adoption rates may be exaggerating the true rate of diffusion. (Am J Med Qual 2007;22:319-326)

Investigating Response Bias in an Information Technology Survey of Physicians

Monitoring the diffusion of electronic health records (EHR) into ambulatory clinical practice has important policy implications. However, estimates of EHR use are typically derived from survey data and may be subject to significant response bias. The current study is a retrospective analysis testing for response bias in a large information technology survey of physicians (n=14,921). To detect bias, respondents were compared to nonrespondents on known characteristics. Moreover, early respondents were compared to late respondents with respect to key variables in the survey that are likely to influence participation. The 4203 respondents (28.2% participation rate) did not differ demographically from nonrespondents. Response rates, by specialty, differed slightly. When comparing early and late survey respondents, no differences were detected in EHR use, length of time since EHR installation, practice size, physician age, years since medical school graduation, and years of practice in their current community. Overall, response bias was not detected using established methodologies in this mailed survey of physician EHR use. Similar surveys of physicians, even with a lower than expected response rate, may still be valid.

Patient Safety-Related Information Technology Utilization in Urban and Rural Hospitals

Ongoing research has linked certain information technology applications to reduction of medical errors and improved patient outcomes. The purpose of this study was to assess both the use of patient safety-related information technologies (PSIT) in urban and rural hospitals, as well as the organizational factors which may be linked to overall PSIT adoption. Florida’s 199 acute care hospitals (170 urban; 29 rural) were surveyed regarding their utilization of PSIT. Of the 10 technologies studied, rural hospitals averaged 30% utilization compared to 48% for urban hospitals. Individual PSIT applications such as pharmacy-based systems, clinical decision support systems, and outcomes and quality management tools were all more likely to be present in urban hospitals. Hospital bed size (less than 100 beds), tax status (not-for-profit vs. for-profit), and system-affiliation appeared to be related to overall PSIT utilization. These findings are valuable for those interested in the current status of hospital PSIT and set the stage for further studies relating these applications to clinical outcomes in urban and rural hospitals.

The Use of Information Technologies Among Rural and Urban Physicians in Florida

This study examines rural–urban differences in the use of various information technologies (IT) applications by physicians in the ambulatory setting. Findings suggest that no differences exist between rural and urban physicians with respect to the use of a computer (77.4 vs 81.4; pu2009=u2009.144) or with the availability of an Internet connection (95.0 vs 96.5; pu2009=u2009.249) in the office. However, rural physicians were significantly less likely than urban doctors to indicate using e-mail with patients (7.9 vs 17.2%; pu2009<u2009.001) and slightly less likely to use a personal digital assistant (PDA) (32.3 vs 37.9; pu2009=u2009.091). Rural doctors were significantly less likely to indicate routinely using an electronic health records (EHR) system (17.6 vs 24.1; pu2009=u2009.020). EHR differences between rural and urban physicians were not significant (pu2009=u2009.124) in multivariate analyses and were explained away by practice size (pu2009<u2009.001) and practice type (pu2009=u2009.015). Most barriers to EHR did not differ between rural and urban physicians. However, rural physicians more commonly cited barriers associated with temporary disruptions to productivity or disruptions in access to records when computers systems fail. In sum, EHR use and patient e-mailing is less common in rural areas. While much of this variability can be explained by rural practice characteristics, these findings illustrate the need for further efforts to identify and alleviate barriers and encourage health IT adoption in rural areas.

Charting the use of electronic health records and other information technologies among child health providers.

BackgroundPrevious studies regarding the use of information technologies (IT) specifically among pediatricians and other physicians who treat children are lacking. As such, the objective of this study is to examine the use of electronic health record (EHR) systems and other IT applications among pediatricians and other child health providers (CHPs) in Florida.MethodsWe focus on pediatricians and other CHPs who responded to a state-wide physician survey of IT use. CHPs included general pediatricians, pediatric sub-specialists, and family physicians who self-reported a practice composition of at least 20% children. We compared general pediatricians to other CHPs and all CHPs (including pediatricians) to other physicians with respect to computer and internet availability, and to the use of personal digital assistants and EHRs. Those with an EHR were also compared regarding the availability of key functions available in their system. Statistical analyses included chi-square analysis and logistic regression models which controlled for numerous factors.ResultsA total of 4,203 surveys (28.2% response) including 1,021 CHPs, were returned. General pediatricians (13.7%) were significantly less likely to be using an EHR than both CHP family physicians (26.1%) and pediatric sub-specialists (29.6%; p < .001). In multivariate analysis, only general pediatricians were significantly less likely than other physicians to indicate the use of an EHR system (OR = .43; 95% C.I. = .29 – .64). Overall, CHPs were less likely to have key functions available in their EHR system including electronic prescribing (53.3% vs. 61.9%; p = .028), and electronic order entry (47.7% vs. 57.2%; p = .017) among others. General pediatricians and pediatric sub-specialists frequently lagged behind CHP family physicians with respect to key EHR functions. In contrast, CHPs had growth charts (51.3% vs. 24.0%; p < .001) and weight-based dosing functions (35.5% vs.22.7%; p < .001) more frequently than others.ConclusionPhysicians caring for children, and especially pediatricians, in Florida, are significantly slower than other doctors to adopt EHRs, and important electronic patient safety functionalities, into their office practices.

A comparative study of quality outcomes in freestanding ambulatory surgery centers and hospital-based outpatient departments: 1997-2004.

RESEARCH OBJECTIVEnTo compare quality outcomes from surgical procedures performed at freestanding ambulatory surgery centers (ASCs) and hospital-based outpatient departments (HOPDs).nnnDATA SOURCESnPatient-level ambulatory surgery (1997-2004), hospital discharge (1997-2004), and vital statistics data (1997-2004) for the state of Florida were assembled and analyzed.nnnSTUDY DESIGNnWe used a pooled, cross-sectional design. Logistic regressions with time fixed-effects were estimated separately for the 12 most common ambulatory surgical procedures. Our quality outcomes were risk-adjusted 7-day and 30-day mortality and 7-day and 30-day unexpected hospitalizations. Risk-adjustment for patient demographic characteristics and severity of illness were calculated using the DCG/HCC methodology adjusting for primary diagnosis only and separately for all available diagnoses.nnnPRINCIPAL FINDINGSnAlthough neither ASCs nor HOPDs performed better overall, we found some difference by procedure that varied based on the risk-adjustment approach used.nnnCONCLUSIONSnThere appear to be important variations in quality outcomes for certain procedures, which may be related to differences in organizational structure, processes, and strategies between ASCs and HOPDs. The study also confirms the importance of risk-adjustment for comorbidities when using administrative data, particularly for procedures that are sensitive to differences in severity.