title: Opioid prescribing by physicians with and without electronic health records.
abstract: BACKGROUND
  Physicians in the U.S. are adopting electronic health records (EHRs) at an unprecedented rate. However, little is known about how EHR use relates to physicians' care decisions. Using nationally representative data, we estimated how using practice-based EHRs relates to opioid prescribing in primary care.
  
  
  METHODS
  This study analyzed 33,090 visits to primary care physicians (PCPs) in the 2007-2010 National Ambulatory Medical Care Survey. We used logistic regression to compare opioid prescribing by PCPs with and without EHRs.
  
  
  RESULTS
  Thirteen percent of all visits and 33 % of visits for chronic noncancer pain resulted in an opioid prescription. Compared to visits without EHRs, visits to physicians with EHRs had 1.38 times the odds of an opioid prescription (95 % CI, 1.22-1.56). Among visits for chronic noncancer pain, physicians with EHRs had significantly higher odds of an opioid prescription (adj. OR = 1.39; 95 % CI, 1.03-1.88). Chronic pain visits involving electronic clinical notes were also more likely to result in an opioid prescription compared to chronic pain visits without (adj. OR = 1.51; 95 % CI, 1.10-2.05). Chronic pain visits involving electronic test ordering were also more likely to result in an opioid prescription compared to chronic pain visits without (adj. OR = 1.31; 95 % CI, 1.01-1.71).
  
  
  CONCLUSIONS
  We found higher levels of opioid prescribing among physicians with EHRs compared to those without. These results highlight the need to better understand how using EHR systems may influence physician prescribing behavior so that EHRs can be designed to reliably guide physicians toward high quality care.
authors.affiliation: Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO BOX 100195, Gainesville, FL, 32611, USA, charle@phhp.ufl.edu.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Harle
authors.forename: Robert L
authors.initials: RL
authors.lastname: Cook
authors.forename: Heidi S
authors.initials: HS
authors.lastname: Kinsell
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000701:Analgesics, Opioid