title: Correlates of electronic health record adoption in office practices: a statewide survey.
abstract: OBJECTIVE
  Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption.
  
  
  METHODS
  Mailed survey to a stratified random sample of all medical practices in Massachusetts in 2005, with one physician per practice randomly selected for survey.
  
  
  METHODS
  EHR adoption rates.
  
  
  RESULTS
  The response rate was 71% (1345/1884). Overall, while 45% of physicians were using an EHR, EHRs were present in only 23% of practices. In multivariate analysis, practice size was strongly correlated with EHR adoption; 52% of practices with 7 or more physicians had an EHR, as compared with 14% of solo practices (adjusted odds ratio, 3.66; 95% confidence interval, 2.28-5.87). Hospital-based practices (adjusted odds ratio, 2.44; 95% confidence interval, 1.53-3.91) and practices that teach medical students or residents (adjusted odds ratio, 2.30; 95% confidence interval, 1.60-3.31) were more likely to have an EHR. The most frequently cited barriers to adoption were start-up financial costs (84%), ongoing financial costs (82%), and loss of productivity (81%).
  
  
  CONCLUSIONS
  While almost half of physicians in Massachusetts are using an EHR, fewer than one in four practices in Massachusetts have adopted EHRs. Adoption rates are lower in smaller practices, those not affiliated with hospitals, and those that do not teach medical students or residents. Interventions to expand EHR use must address both financial and non-financial barriers, especially among smaller practices.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215, USA. steven_simon@hphc.org
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Jenter
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Helen G
authors.initials: HG
authors.lastname: Lo
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Williams
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D001292:Attitude to Computers; D003197:Computer Literacy; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D006801:Humans; D008404:Massachusetts; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D015279:Organizational Culture; D011216:Practice Management, Medical / Q000458:organization & administration*; D011795:Surveys and Questionnaires