Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study

The Article in Brief

Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study

Diane R. Rittenhouse , and colleagues

Background Health information technology (HIT) is one of the foundations of high-performing primary care, but adoption of HIT by primary care practices is far from universal. This study analyzes data from telephone surveys of small primary care practices to better understand the correlates of greater health information technology implementation.

What This Study Found Sixteen out of 18 measures of health information functionality increased during the study period, with largest gains among hospital-owned practices, practices with 3 to 8 (versus 1 to 2) physicians, practices with more Medicare patients, and those participating in pay-for-performance or public reporting of quality data. Physician use of electronic health records to collect quality data increased from 17 percent to 42 percent and e-prescribing increased from 25 percent to 70 percent over time. Hospital-owned practices used on average 1.5 more HIT processes than physician-owned practices, and practices with 3 to 8 physicians used 2.5 more HIT processes than smaller practices. External incentives (participation in pay-for-performance programs, participation in public reporting of clinical quality data, and greater proportion of revenue from Medicare) were also positively associated with greater adoption and use of HIT, although the effect sizes were smaller. The authors note that despite substantial increases in adoption and use of HIT, there remains ample room for improvement. Fewer than 50 percent of practices reported using most EHR functionalities. Only one in five practices used e-mail with patients or allowed patients to see their medical records online, and maintenance of electronic registries for the management of chronic disease was also low.

Implications

• The authors conclude that targeting assistance to smaller, physician-owned practices and offering payment incentives and technical support would help encourage uptake and use of HIT in primary care.