Physician Beliefs about the Meaningful Use of the Electronic Health Record: A Follow-Up Study

Abstract

Background There is continuing interest in how physicians are responding to the meaningful use of the electronic health record (EHR) incentive program. However, little research has been done on physician beliefs about the meaningful use of the EHR.

Objective This study aims to conduct a follow-up study of physician beliefs about the meaningful use of the EHR.

Methods Online survey of physicians at two academic medical centers (AMCs) in the northeast who were participating in the meaningful use of the EHR incentive program and were using an internally developed EHR was conducted.

Results Of the 2,033 physicians surveyed, 1,075 completed the survey for an overall response rate of 52.9%. Only one-fifth (20.5%) of the physicians agreed or strongly agreed that meaningful use of the EHR would help them improve quality of care, and only a quarter (25.2%) agreed or strongly agreed that the meaningful use of the EHR would improve the care that their organization delivers. Physician satisfaction with the outpatient EHR was the strongest predictor of self-efficacy with achieving stage 2 of the meaningful use of the EHR incentive program (odds ratio: 2.10, 95% confidence interval: 1.61, 2.75, p < 0.001). Physicians reported more negative beliefs in stage 2 than stage 1 across all belief items. For example, 28.1% agreed or strongly agreed that the meaningful use of the EHR would decrease medical errors in stage 2 as compared with 35.9% in stage 1 (p < 0.001).

Conclusion Only one-fifth of the physicians in our study believed that the meaningful use of the EHR would improve quality of care, patient-centeredness of care, or the care they personally provide. Primary care physicians expressed more negative beliefs about the meaningful use of the EHR in stage 2 than in stage 1. These findings show that physicians continue to express negative beliefs about the meaningful use of the EHR. These ongoing negative beliefs are concerning for both implementation and policy.

Keywords

electronic health records - physicians - beliefs - meaningful use - self-efficacy

• References

• 1 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504
• 2 Buntin MB, Jain SH, Blumenthal D. Health information technology: laying the infrastructure for national health reform. Health Aff (Millwood) 2010; 29 (06) 1214-1219
• 3 Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med 2007; 167 (13) 1400-1405
• 4 Samal L, Wright A, Healey MJ, Linder JA, Bates DW. Meaningful use and quality of care. JAMA Intern Med 2014; 174 (06) 997-998
• 5 Grabenbauer L, Fraser R, McClay J. , et al. Adoption of electronic health records: a qualitative study of academic and private physicians and health administrators. Appl Clin Inform 2011; 2 (02) 165-176
• 6 Grabenbauer L, Skinner A, Windle J. Electronic health record adoption–maybe it's not about the money: physician super-users, electronic health records and patient care. Appl Clin Inform 2011; 2 (04) 460-471
• 7 Weeks DL, Keeney BJ, Evans PC, Moore QD, Conrad DA. Provider perceptions of the electronic health record incentive programs: a survey of eligible professionals who have and have not attested to meaningful use. J Gen Intern Med 2015; 30 (01) 123-130
• 8 Emani S, Ting DY, Healey M. , et al. Physician beliefs about the impact of meaningful use of the EHR: a cross-sectional study. Appl Clin Inform 2014; 5 (03) 789-801
• 9 Emani S, Ting DY, Healey M. , et al. Physician perceptions and beliefs about generating and providing a clinical summary of the office visit. Appl Clin Inform 2015; 6 (03) 577-590
• 10 Jha AK. Meaningful use of electronic health records: the road ahead. JAMA 2010; 304 (15) 1709-1710
• 11 Abbett SK, Bates DW, Kachalia A. The meaningful use regulations in information technology: what do they mean for quality improvement in hospitals?. Jt Comm J Qual Patient Saf 2011; 37 (07) 333-336 , 289
• 12 Hogan SO, Kissam SM. Measuring meaningful use. Health Aff (Millwood) 2010; 29 (04) 601-606
• 13 Hsiao CJ, Decker SL, Hing E, Sisk JE. Most physicians were eligible for federal incentives in 2011, but few had EHR systems that met meaningful-use criteria. Health Aff (Millwood) 2012; 31 (05) 1100-1107
• 14 Decker SL, Jamoom EW, Sisk JE. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. Health Aff (Millwood) 2012; 31 (05) 1108-1114
• 15 Xierali IM, Phillips Jr RL, Green LA, Bazemore AW, Puffer JC. Factors influencing family physician adoption of electronic health records (EHRs). J Am Board Fam Med 2013; 26 (04) 388-393
• 16 Heisey-Grove D, King JA. Physician and practice-level drivers and disparities around meaningful use progress. Health Serv Res 2017; 52 (01) 244-267
• 17 Hosmer DW, Lemeshow S. Special Topics. In: Applied Logistic Regression, Second Edition. Hoboken, NJ: John Wiley & Sons, Inc.; 2000
• 18 Mitchell J, Waldren SE. Making sense of meaningful use stage 2: second wave or tsunami?. Fam Pract Manag 2014; 21 (01) 19-24
• 19 Ralston JD, Coleman K, Reid RJ, Handley MR, Larson EB. Patient experience should be part of meaningful-use criteria. Health Aff (Millwood) 2010; 29 (04) 607-613
• 20 DesRoches CM, Audet A-M, Painter M, Donelan K. Meeting meaningful use criteria and managing patient populations: a national survey of practicing physicians. Ann Intern Med 2013; 158 (11) 791-799
• 21 Makam AN, Lanham HJ, Batchelor K. , et al. Use and satisfaction with key functions of a common commercial electronic health record: a survey of primary care providers. BMC Med Inform Decis Mak 2013; 13: 86
• 22 Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84 (02) 191-215
• 23 Zandieh SO, Abramson EL, Pfoh ER, Yoon-Flannery K, Edwards A, Kaushal R. Transitioning between ambulatory EHRs: a study of practitioners' perspectives. J Am Med Inform Assoc 2012; 19 (03) 401-406
• 24 Chiang MF, Boland MV, Brewer A. , et al; American Academy of Ophthalmology Medical Information Technology Committee. Special requirements for electronic health record systems in ophthalmology. Ophthalmology 2011; 118 (08) 1681-1687
• 25 Cabana MD, Kim C. Physician adherence to preventive cardiology guidelines for women. Womens Health Issues 2003; 13 (04) 142-149
• 26 Fernald DH, Wearner R, Dickinson WP. The journey of primary care practices to meaningful use: a Colorado Beacon Consortium study. J Am Board Fam Med 2013; 26 (05) 603-611
• 27 Shea CM, Reiter KL, Weaver MA. , et al. Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system. BMC Med Inform Decis Mak 2014; 14: 119