Market effects on electronic health record adoption by physicians
Market effects on electronic health record adoption by physicians
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DOI：
10.1097/01.hmr.0000324904.19272.c2
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发表时间：
2008-07-01
影响因子：
2.5
通讯作者：
Brooks, Robert G.
中科院分区：
文献类型：
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作者：
Abdolrasulnia, Maziar;Menachemi, Mir;Brooks, Robert G.
背景：尽管电子健康记录(EHR)系统具有优势，但在社区医生中采用这些系统的速度很慢。目前的研究已经考察了组织和个人采用电子病历的障碍，但尚未研究市场特征对物理学家采用电子病历的影响。目的：本研究的目的是测量市场特征对物理学家采用电子病历的影响。方法：使用广义层次线性模型分析佛罗里达州的电子病历调查数据，结合地区资源文件和佛罗里达州保险监管办公室的数据。主要结果变量是医生使用电子病历的自我报告。结果：样本中包括了来自20个或更少执业规模的2926名医生。21%(n=613)的人表示，他们个人经常在实践中使用电子健康记录系统。研究发现，位于医生集中度较高的县的医生更有可能采用EHR。该县每10,000名非联邦医生每增加一个单位，医生采用电子病历的可能性就增加2.0%(优势比=1.02，可信区间=1.00-1.03)。健康维护组织渗透率和贫困程度与采用电子健康记录没有显著关系。然而，诊所规模、执业年限、医疗保险支付者组合和技术准备程度的衡量标准被发现独立地影响医生的采用。实践启示：市场因素在小型医疗机构中电子病历的传播中发挥着重要作用。有兴趣进一步采用电子健康记录的政策制定者必须考虑能够增强用户信心的战略，并在小型医疗机构和医疗保险受益人最集中的地区提供财政支持。卫生保健领导者应该认识到在他们的实践中和他们的竞争对手的实践中促进或限制采用EHR的市场力量。
Background: Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied.Purpose: The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians.Methodology: Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians.Findings: A total of 2,926 physicians from practice sizes of 20 or lesswere included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption.Practice Implications: Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.