Abdolrasulnia Maziar, Menachemi Nir, Shewchuk Richard M, Ginter Peter M, Duncan W Jack, Brooks Robert G
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, USA.
Health Care Manage Rev. 2008 Jul-Sep;33(3):243-52. doi: 10.1097/01.HMR.0000324904.19272.c2.
Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied.
The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians.
Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians.
A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption.
Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.
尽管电子健康记录（EHR）系统具有诸多优势，但社区医生对这些系统的采用速度一直较慢。目前的研究已经考察了采用过程中的组织和个人障碍；然而，市场特征的影响尚未得到研究。
本研究的目的是衡量市场特征对医生采用电子健康记录的影响。
采用广义分层线性模型分析来自佛罗里达州的电子健康记录调查数据，并将其与来自区域资源文件和佛罗里达州保险监管办公室的数据相结合。主要结果变量是医生自我报告的电子健康记录使用情况。
样本包括2926名来自规模为20人及以下诊所的医生。21%（n = 613）表示他们在自己的诊所中个人且常规地使用电子健康记录系统。研究发现，位于医生集中度较高县的医生更有可能采用电子健康记录。每10000名县内非联邦医生增加一个单位，医生采用电子健康记录的可能性就增加2.0%（优势比 = 1.02，置信区间 = 1.00 - 1.03）。未发现健康维护组织渗透率和贫困水平与电子健康记录采用显著相关。然而，诊所规模、从业年限、医疗保险支付方组合以及技术准备程度指标被发现独立影响医生的采用情况。
市场因素在小型医疗诊所电子健康记录的推广中起着重要作用。希望进一步推动电子健康记录采用的政策制定者必须考虑能够增强用户信心的策略，并在小型医疗诊所和医疗保险受益人集中度最高的地区提供财政支持。医疗保健领导者应该认识到那些促进或限制其诊所及竞争对手诊所采用电子健康记录系统的市场力量。
