Clinician characteristics and use of novel electronic health record functionality in primary care
- Jeffrey A Linder1,2,
- Nancy A Rigotti2,3,
- Louise I Schneider1,2,
- Jennifer H K Kelley3,
- Phyllis Brawarsky1,
- Jeffrey L Schnipper1,2,
- Blackford Middleton1,2,
- Jennifer S Haas1,2
- 1Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- 2Harvard Medical School, Boston, Massachusetts, USA
- 3Tobacco Research and Treatment Center and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA
- Correspondence to Dr Jeffrey A Linder, Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, BC-3-2X, Boston, MA 02120, USA;
- Received 25 April 2011
- Accepted 18 August 2011
- Published Online First 7 September 2011
Background Conventional wisdom holds that older, busier clinicians who see complex patients are less likely to adopt and use novel electronic health record (EHR) functionality.
Methods To compare the characteristics of clinicians who did and did not use novel EHR functionality, we conducted a retrospective analysis of the intervention arm of a randomized trial of new EHR-based tobacco treatment functionality.
Results The novel functionality was used by 103 of 207 (50%) clinicians. Staff physicians were more likely than trainees to use the functionality (64% vs 37%; p<0.001). Clinicians who graduated more than 10 years previously were more likely to use the functionality than those who graduated less than 10 years previously (64% vs 42%; p<0.01). Clinicians with higher patient volumes were more likely to use the functionality (lowest quartile of number of patient visits, 25%; 2nd quartile, 38%; 3rd quartile, 65%; highest quartile, 71%; p<0.001). Clinicians who saw patients with more documented problems were more likely to use the functionality (lowest tertile of documented patient problems, 38%; 2nd tertile, 58%; highest tertile, 54%; p=0.04). In multivariable modeling, independent predictors of use were the number of patient visits (OR 1.2 per 100 additional patients; 95% CI 1.1 to 1.4) and number of documented problems (OR 2.9 per average additional problem; 95% CI 1.4 to 6.1).
Conclusions Contrary to conventional wisdom, clinically busier physicians seeing patients with more documented problems were more likely to use novel EHR functionality.
- Electronic health records
- physicians' practice patterns
- primary health care
- decision support systems
- human-computer interaction and human-centered computing
- developing/using clinical decision support (other than diagnostic) and guideline systems
- other specific EHR applications (results review)
- medication administration
- disease progression
- quality improvement
- patient safety
- clinical decision support
- hospital medicine
- image managem
- knowledge representations
- uncertain reasoning and decision theory
- designing usable (responsive) resources and systems
- personal health records and self-care systems
- knowledge acquisition and knowledge management
- demonstrating return on it investment
Funding This study was supported by grants from the National Cancer Institute (R21 CA121906) and the Agency for Healthcare Research and Quality (R01 HS015169-01). Dr Linder was supported by a career development award from the Agency for Healthcare Research and Quality (K08 HS014563). Dr Schnipper was supported by a mentored career development award from the National Heart, Lung, and Blood Institute (1K08 HL072806-01).
Competing interests None.
Ethics approval The Partners Human Research Committee approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.