title: Local public health department adoption and use of electronic health records.
abstract: BACKGROUND
  Electronic health records (EHRs) may help local health departments (LHDs) to improve services and thereby promote and protect population health. Yet, little is known about nationwide trends and correlates of EHR use by LHDs.
  
  
  OBJECTIVE
  We examine relative contributions of LHD finances, leadership, and governance to EHR adoption and use from 2010 to 2013. The impact of LHD service provision and meaningful use factors on EHR use is explored in depth.
  
  
  METHODS
  Combining data from the National Association of County & City Health Officials Profile survey and the Area Health Resource File, logistic regression models were used to examine EHR use in 2013. Multinomial logistic models examined EHR adoption, use, or discontinuation from 2010 to 2013.
  
  
  METHODS
  EHR usage data were available for 514 and 488 LHDs in 2010 and 2013, respectively. A total of 117 LHDs had data for both 2010 and 2013.
  
  
  METHODS
  Outcomes included dichotomized measures of LHD self-reported use of EHRs in 2010 and 2013. For LHDs with 2 years of data, a 4-category variable measuring self-reported EHR use, nonuse, adoption, or discontinuation was analyzed.
  
  
  RESULTS
  Overall LHD EHR use did not increase significantly between 2010 (19.3%) and 2013 (22.0%). While 15% of LHDs reported adopting EHRs from 2010 to 2013, another 8.5% reported discontinuing use of EHRs during this time. Likelihood of EHR use was strongly associated with LHD clinical service characteristics, per capita expenditures, and state governance structure.
  
  
  CONCLUSIONS
  EHRs do not appear to be rapidly diffusing across LHDs, and retention of current systems may be a concern. Given trends away from clinical service provision and other pressing demands for LHD resources, the benefits of EHR adoption are unclear.
authors.affiliation: School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix (Dr McCullough); Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles (Dr Zimmerman); General Internal Medicine, Geffen School of Medicine, University of California, Los Angeles (Dr Bell); and Division of Health Policy & Management, School of Public Health, University of California, Berkeley, Berkeley, California (Dr Rodriguez).
authors.forename: J Mac
authors.initials: JM
authors.lastname: McCullough
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Zimmerman
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Bell
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
mesh_terms: D003695:Delivery of Health Care / Q000379:methods; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records; D006801:Humans; D009111:Local Government; D011634:Public Health / Q000379:methods*; D011795:Surveys and Questionnaires