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DOI: 10.4338/ACI-2014-05-RA-0050
Physician beliefs about the impact of meaningful use of the EHR
A Cross-Sectional StudyCorrespondence to:
Publication History
received:
11 May 2014
accepted:
18 July 2014
Publication Date:
19 December 2017 (online)
Summary
Background: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.
Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.
Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.
Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.
Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.
Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801
http://dx.doi.org/10.4338/ACI-2014-05-RA-0050
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Conflicts of interest
The authors report no conflicts of interest in the research.
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References
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- 2 Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504.
- 3 Buntin MB, Jain SH, Blumenthal D. Health information technology: laying the infrastructure for national health reform. Health Aff (Millwood) 2010; 29 (06) 1214-1219.
- 4 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.
- 5 Grabenbauer L, Fraser R, McClay J, Woelfl N, Thompson CB, Cambell J, Windle J. Adoption of EHR –a qualitative study of academic and private physicians and health administrators. Appl Clin Inform 2011; 2: 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: 460-471.
- 7 Soares N, Vyas K, Perry B. Clinician perceptions of pediatric growth chart use and electronic health records in Kentucky. Appl Clin Inform 2012; 3: 437-447.
- 8 Holden RJ. Physicians’ beliefs about using EMR and CPOE: In pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 (02) 71-80.
- 9 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.
- 10 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.
- 11 Menachemi N, Brooks RG. EHR and other IT adoption among physicians: Results of a large-scale statewide analysis. J Healthc Inf Manag 2006; 20 (03) 79-87.
- 12 Xieroli IM, Phillips 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.
- 13 Jha AK. Meaningful use of electronic health records: the road ahead. JAMA 2010; 304 (15) 1709-1710.
- 14 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.
- 15 Hogan SO, Kissam SM. Measuring meaningful use. Health Aff (Millwood) 2010; 29 (04) 601-606.
- 16 Cabana MD, Kim C. Physician adherence to preventive cardiology guidelines for women. Womens Health Issues 2003; 13 (04) 142-149.
- 17 Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282 (15) 1458-1465.
- 18 Bandura A. Self-efficacy: Toward a unifying theory of behavior change. Psychological Review 1977; 84 (02) 191-215.
- 19 Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986
- 20 Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley; 2000
- 21 Holt DT, Helfrich CD, Hall CG, Weiner BJ. Are you ready? How health professionals can comprehensively conceptualize readiness for change. J Gen Intern Med 2009; 25 01 50-55.
- 22 DesRoches CM, Audet A-M, Painter M, Donelan K. Meeting meaningful use criteria and managing patient populations. Ann Intern Med 2013; 158: 791-799.
- 23 Chiang MF, Boland MV, Brewer A. et al. Special requirements for electronic health records in Ophthalmology. Ophthalmology 2011; 118: 1681-1687.
- 24 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: 401-406.
- 25 Gold MR, McLaughlin CG, Devers KJ, Berenson RA, Bovbjerg RR. Obtaining providers’ ’buy-in’ and establishing effective means of information exchange will be critical to HITECH’s success. Health Aff (Mill-wood) 2012; 31 (03) 514-526.
- 26 Harle CA, Huerta TR, Ford EW, Diana ML, Menachemi N. Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011. J Am Med Inform Assoc 2013; 20 (02) 233-237.
Correspondence to:
-
References
- 1 Kim GR, Lehmann CU. In search of dialogue and discourse in applied clinical informatics. Appl Clin Inform 2009; 0: 1-7.
- 2 Blumenthal D, Tavenner M. The „meaningful use“ regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504.
- 3 Buntin MB, Jain SH, Blumenthal D. Health information technology: laying the infrastructure for national health reform. Health Aff (Millwood) 2010; 29 (06) 1214-1219.
- 4 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.
- 5 Grabenbauer L, Fraser R, McClay J, Woelfl N, Thompson CB, Cambell J, Windle J. Adoption of EHR –a qualitative study of academic and private physicians and health administrators. Appl Clin Inform 2011; 2: 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: 460-471.
- 7 Soares N, Vyas K, Perry B. Clinician perceptions of pediatric growth chart use and electronic health records in Kentucky. Appl Clin Inform 2012; 3: 437-447.
- 8 Holden RJ. Physicians’ beliefs about using EMR and CPOE: In pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79 (02) 71-80.
- 9 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.
- 10 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.
- 11 Menachemi N, Brooks RG. EHR and other IT adoption among physicians: Results of a large-scale statewide analysis. J Healthc Inf Manag 2006; 20 (03) 79-87.
- 12 Xieroli IM, Phillips 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.
- 13 Jha AK. Meaningful use of electronic health records: the road ahead. JAMA 2010; 304 (15) 1709-1710.
- 14 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.
- 15 Hogan SO, Kissam SM. Measuring meaningful use. Health Aff (Millwood) 2010; 29 (04) 601-606.
- 16 Cabana MD, Kim C. Physician adherence to preventive cardiology guidelines for women. Womens Health Issues 2003; 13 (04) 142-149.
- 17 Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282 (15) 1458-1465.
- 18 Bandura A. Self-efficacy: Toward a unifying theory of behavior change. Psychological Review 1977; 84 (02) 191-215.
- 19 Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall; 1986
- 20 Hosmer DW, Lemeshow S. Applied Logistic Regression. New York: Wiley; 2000
- 21 Holt DT, Helfrich CD, Hall CG, Weiner BJ. Are you ready? How health professionals can comprehensively conceptualize readiness for change. J Gen Intern Med 2009; 25 01 50-55.
- 22 DesRoches CM, Audet A-M, Painter M, Donelan K. Meeting meaningful use criteria and managing patient populations. Ann Intern Med 2013; 158: 791-799.
- 23 Chiang MF, Boland MV, Brewer A. et al. Special requirements for electronic health records in Ophthalmology. Ophthalmology 2011; 118: 1681-1687.
- 24 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: 401-406.
- 25 Gold MR, McLaughlin CG, Devers KJ, Berenson RA, Bovbjerg RR. Obtaining providers’ ’buy-in’ and establishing effective means of information exchange will be critical to HITECH’s success. Health Aff (Mill-wood) 2012; 31 (03) 514-526.
- 26 Harle CA, Huerta TR, Ford EW, Diana ML, Menachemi N. Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011. J Am Med Inform Assoc 2013; 20 (02) 233-237.