J Am Med Inform Assoc 18:271-275 doi:10.1136/amiajnl-2010-000010
  • Research and applications

Electronic health records in small physician practices: availability, use, and perceived benefits

  1. Ashish K Jha3
  1. 1Mongan Institute for Health Policy, Massachusetts General Hospital, Biostatistics Center, Boston, Massachusetts, USA
  2. 2Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Professor Ashish K Jha, Department of Health Policy and Management, Harvard School of Public Health, Division of General Medicine, Brigham and Women's Hospital, Veterans Affairs Boston Healthcare System, 677 Huntington Avenue, Boston, MA 02115, USA; ajha{at}
  • Received 23 August 2010
  • Accepted 28 February 2011


Objective To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size.

Design Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association.

Measurements We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care.

Results With a response rate of 62%, we found that <2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21–46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13–16%) and statistically significant (p<0.001). All adopters reported similar benefits.

Limitations Although we have adjusted for response bias, influences may still exist.

Conclusion Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.


  • Funding This study was supported by the Office of the National Coordinator for Health Information Technology and a grant from the Robert Wood Johnson Foundation. Drs Rao and Donelan report receiving grant support from GE Corporation Healthcare, and Dr Jha reports receiving consulting fees from UpToDate.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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