title: Use of electronic medical records differs by specialty and office settings.
abstract: OBJECTIVE
  To assess differences in the use of electronic medical records (EMRs) among medical specialties and practice settings.
  
  
  METHODS
  A cross-sectional retrospective study using nationally representative data from the National Ambulatory Medical Care Survey for the period 2003-2010 was performed. Bivariate and multivariate analyzes compared EMR use among physicians of 14 specialties and assessed variation by practice setting. Differences in EMR use by geographic region, patient characteristics, and physician office settings were also assessed.
  
  
  RESULTS
  Bivariate and multivariate analysis demonstrated increased EMR use from 2003 to 2010, with 16% reporting at least partial use in 2003, rising to 52% in 2010 (p<0.001). Cardiologists, orthopedic surgeons, urologists, and family/general practitioners had higher frequencies of EMR use whereas psychiatrists, ophthalmologists, and dermatologists had the lowest EMR use. Employed physicians had higher EMR uptake than physicians who owned their practice (48% vs 31%, p<0.001). EMR uptake was lower among solo practitioners (23%) than non-solo practitioners (42%, p<0.001). Practices owned by Health Maintenance Organizations had higher frequencies of EMR use (83%) than practices owned by physicians, community health centers, or academic centers (all <45%, p<0.001). Patient demographics did not affect EMR use (p>0.05).
  
  
  CONCLUSIONS
  Uptake of EMR is increasing, although it is significantly slower in dermatology, ophthalmology, and psychiatry. Solo practitioners and owners of a practice have low frequencies of EMR use compared with non-solo practitioners and those who do not own their practice. Despite incentives for EMR adoption, physicians should carefully weigh which, if any, EMR to adopt in their practices.
authors.affiliation: Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157-1071, USA.
authors.forename: Erik W J
authors.initials: EW
authors.lastname: Kokkonen
authors.forename: Scott A
authors.initials: SA
authors.lastname: Davis
authors.forename: Hsien-Chang
authors.initials: HC
authors.lastname: Lin
authors.forename: Tushar S
authors.initials: TS
authors.lastname: Dabade
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
mesh_terms: D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006123:Group Practice / Q000706:statistics & numerical data; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008511:Medicine; D015999:Multivariate Analysis; D011216:Practice Management, Medical / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: EMR; NAMCS; technology
references.citation: Health Aff (Millwood). 2011 Mar;30(3):464-71
references.pmid: 21383365
references.citation: Health Aff (Millwood). 2011 Aug;30(8):1575-84
references.pmid: 21719447
references.citation: Proc AMIA Symp. 2001;:194-8
references.pmid: 11825179
references.citation: Fam Pract Manag. 2002 Oct;9(9):35-8
references.pmid: 12416414
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1103-17
references.pmid: 16162551
references.citation: AMIA Annu Symp Proc. 2006;:394-8
references.pmid: 17238370
references.citation: N Engl J Med. 2009 Mar 12;360(11):1057-60
references.pmid: 19224738
references.citation: N Engl J Med. 2008 Jul 3;359(1):50-60
references.pmid: 18565855
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1334-43
references.pmid: 16162581
references.citation: Arch Intern Med. 2011 May 23;171(10):897-903
references.pmid: 21263077
references.citation: J Pain Palliat Care Pharmacother. 2015 Jun;29(2):133-9
references.pmid: 26095483
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1323-33
references.pmid: 16162580
references.citation: Evid Rep Technol Assess (Full Rep). 2006 Apr;(132):1-71
references.pmid: 17627328
references.citation: Arch Intern Med. 2007 Jul 9;167(13):1400-5
references.pmid: 17620534
references.citation: Perspect Health Inf Manag. 2010 Oct 01;7:1d
references.pmid: 21063545
references.citation: NCHS Data Brief. 2011 Nov;(79):1-8
references.pmid: 22617322
references.citation: N Engl J Med. 2009 Apr 9;360(15):1477-9
references.pmid: 19321856
references.citation: MedGenMed. 2004 Dec 06;6(4):2
references.pmid: 15775829
references.citation: Health Aff (Millwood). 2004 Mar-Apr;23(2):116-26
references.pmid: 15046136
references.citation: Am J Med. 2003 Apr 1;114(5):397-403
references.pmid: 12714130
references.citation: Health Aff (Millwood). 2012 May;31(5):1100-7
references.pmid: 22535501
references.citation: BMC Med Inform Decis Mak. 2010 Oct 15;10:60
references.pmid: 20950458