title: How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use.
abstract: BACKGROUND
  Studies of the effects of electronic health records (EHRs) have had mixed findings, which may be attributable to unmeasured confounders such as individual variability in use of EHR features.
  
  
  OBJECTIVE
  To capture physician-level variations in use of EHR features, associations with other predictors, and usage intensity over time.
  
  
  METHODS
  Retrospective cohort study of primary care providers eligible for meaningful use at a network of federally qualified health centers, using commercial EHR data from January 2010 through June 2013, a period during which the organization was preparing for and in the early stages of meaningful use.
  
  
  RESULTS
  Data were analyzed for 112 physicians and nurse practitioners, consisting of 430,803 encounters with 99,649 patients. EHR usage metrics were developed to capture how providers accessed and added to patient data (eg, problem list updates), used clinical decision support (eg, responses to alerts), communicated (eg, printing after-visit summaries), and used panel management options (eg, viewed panel reports). Provider-level variability was high: for example, the annual average proportion of encounters with problem lists updated ranged from 5% to 60% per provider. Some metrics were associated with provider, patient, or encounter characteristics. For example, problem list updates were more likely for new patients than established ones, and alert acceptance was negatively correlated with alert frequency.
  
  
  CONCLUSIONS
  Providers using the same EHR developed personalized patterns of use of EHR features. We conclude that physician-level usage of EHR features may be a valuable additional predictor in research on the effects of EHRs on healthcare quality and costs.
authors.affiliation: Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA Health Information Technology Evaluation Collaborative (HITEC), New York, USA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Ancker
authors.affiliation: Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA Health Information Technology Evaluation Collaborative (HITEC), New York, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.affiliation: Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA Health Information Technology Evaluation Collaborative (HITEC), New York, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Edwards
authors.affiliation: Institute for Family Health, New York, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nosal
authors.affiliation: Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Stein
authors.affiliation: Institute for Family Health, New York, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Hauser
authors.affiliation: Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA Health Information Technology Evaluation Collaborative (HITEC), New York, USA.
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000328:Adult; D003658:Decision Making, Computer-Assisted; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: electronic health records; informatics; meaningful use; primary care; technology adoption