Jha Ashish K, Bates David W, Jenter Chelsea, Orav E John, Zheng Jie, Cleary Paul, Simon Steven R
Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
J Eval Clin Pract. 2009 Feb;15(1):158-63. doi: 10.1111/j.1365-2753.2008.00975.x. Epub 2008 Aug 28.
Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers.
We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems.
Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care.
In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minority-serving providers have equal access to EHR systems, we failed to find evidence of a new digital divide.
电子健康记录(EHRs)是提高医疗质量的一项有前景的工具,尽管尚不清楚谁将从这项新技术中受益。鉴于一小部分医疗服务提供者照顾了大多数种族/族裔少数群体,我们试图确定为少数群体服务的医疗服务提供者采用电子健康记录系统的比例是否与其他医疗服务提供者相当。
我们使用了2005年马萨诸塞州所有医疗实践分层随机样本的调查数据。我们确定了电子健康记录的采用率、采用过程中感知到的障碍以及对电子健康记录系统的满意度。
报告患者群体中黑人或西班牙裔比例超过40%的医生,其电子健康记录的采用水平与其他医生相当(分别为27.9%和21.8%,P = 0.46)。来自为少数群体服务的医疗机构的医生以相似的比例指出了实施电子健康记录系统的财务和其他障碍,尽管这些医生不太可能担心电子健康记录的隐私和安全问题(47.1%对64.4%,P = 0.01)。最后,来自少数群体比例高的医疗机构的医生对电子健康记录对医疗质量(73.7%对76.6%,P = 0.43)和成本(46.9%对51.5%,P = 0.17)的积极影响有相似的看法。
在一个少数群体多样化的州,我们没有发现证据表明为少数群体服务的医疗服务提供者的电子健康记录采用率较低、面临不同的采用障碍或对电子健康记录不太满意。鉴于确保为少数群体服务的医疗服务提供者平等使用电子健康记录系统的重要性,我们没有找到新的数字鸿沟的证据。