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J Am Med Inform Assoc 20:e33-e38 doi:10.1136/amiajnl-2012-001609
  • Research and applications

Use of electronic medical records differs by specialty and office settings

  1. Alan B Fleischer Jr1
  1. 1Departments of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana, USA
  3. 3Departments of Pathology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  4. 4Departments of Public Health Sciences, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Scott A Davis, Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA; scdavis{at}wakehealth.edu
  • Received 31 December 2012
  • Revised 7 March 2013
  • Accepted 10 March 2013
  • Published Online First 28 March 2013

Abstract

Objective To assess differences in the use of electronic medical records (EMRs) among medical specialties and practice settings.

Methods A cross-sectional retrospective study using nationally representative data from the National Ambulatory Medical Care Survey for the period 2003–2010 was performed. Bivariate and multivariate analyzes compared EMR use among physicians of 14 specialties and assessed variation by practice setting. Differences in EMR use by geographic region, patient characteristics, and physician office settings were also assessed.

Results Bivariate and multivariate analysis demonstrated increased EMR use from 2003 to 2010, with 16% reporting at least partial use in 2003, rising to 52% in 2010 (p<0.001). Cardiologists, orthopedic surgeons, urologists, and family/general practitioners had higher frequencies of EMR use whereas psychiatrists, ophthalmologists, and dermatologists had the lowest EMR use. Employed physicians had higher EMR uptake than physicians who owned their practice (48% vs 31%, p<0.001). EMR uptake was lower among solo practitioners (23%) than non-solo practitioners (42%, p<0.001). Practices owned by Health Maintenance Organizations had higher frequencies of EMR use (83%) than practices owned by physicians, community health centers, or academic centers (all <45%, p<0.001). Patient demographics did not affect EMR use (p>0.05).

Conclusions Uptake of EMR is increasing, although it is significantly slower in dermatology, ophthalmology, and psychiatry. Solo practitioners and owners of a practice have low frequencies of EMR use compared with non-solo practitioners and those who do not own their practice. Despite incentives for EMR adoption, physicians should carefully weigh which, if any, EMR to adopt in their practices.

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