Li Chenghui
Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, College of Pharmacy, Little Rock, AR, USA.
Perspect Health Inf Manag. 2011;8(Fall):1f. Epub 2011 Oct 1.
This study exploited the unique opportunity to compare estimates of electronic health record (EHR) and specific health information technology (HIT) use for clinical activities by office-based physicians using data from two contemporaneous, nationally representative physician surveys: the 2008 National Ambulatory Medical Care Survey (NAMCS) and the 2008 Health Tracking Physician Survey (HTPS). Survey respondents included 4,117 physicians from the HTPS and 1,187 physicians from the NAMCS. We compared the survey designs and national estimates of EHR and specific HIT use for clinical activities in the two surveys and conducted multivariate analyses examining physician and practice characteristics associated with the adoption of "basic" or "fully functional" systems. The surveys asked nearly identical questions on EHR use. Questions on specific HIT use for clinical activities overlapped but with differences. National estimates of all-EHR use were similar (HTPS 24.31 percent, 95 percent confidence interval [CI]: 22.99-25.69 percent vs. NAMCS 27.24 percent, 95 percent CI: 23.53-31.29 percent), but partial EHR use (i.e., part paper and part electronic) was higher in the HTPS than in the NAMCS (23.93 percent, 95 percent CI: 22.61-25.30 percent vs. 18.40 percent, 95 percent CI: 15.62-21.54 percent in the NAMCS). Both surveys reported low use of "fully functional" systems (HTPS 7.84 percent, 95 percent CI: 7.03-8.73 percent vs. NAMCS 4.56 percent, 95 percent CI 3.09-6.68 percent), but the use of "basic" systems was much higher in the HTPS than in the NAMCS (22.29 percent vs. 11.16 percent). Using multivariate analyses, we found common physician or practice characteristics in the two surveys, although the magnitude of the estimated effects differed. In conclusion, use of a "fully functional" EHR system by office-based physicians was low in both surveys. It may be a daunting task for physicians, particularly those in small practices, to adopt and achieve "meaningful use" in the next two years.
本研究利用独特机会，通过两项同期开展的、具有全国代表性的医生调查数据，即2008年国家门诊医疗护理调查（NAMCS）和2008年健康追踪医生调查（HTPS），比较了门诊医生对电子健康记录（EHR）和用于临床活动的特定健康信息技术（HIT）使用情况的估计。调查对象包括来自HTPS的4117名医生和来自NAMCS的1187名医生。我们比较了两项调查中关于EHR和用于临床活动的特定HIT使用情况的调查设计和全国估计数，并进行了多变量分析，以研究与采用“基本”或“全功能”系统相关的医生和执业特征。两项调查关于EHR使用的问题几乎相同。关于用于临床活动的特定HIT使用情况的问题有重叠但也有差异。所有EHR使用情况的全国估计数相似（HTPS为24.31%，95%置信区间[CI]：22.99 - 25.69%；NAMCS为27.24%，95%CI：23.53 - 31.29%），但HTPS中部分EHR使用情况（即部分纸质部分电子）高于NAMCS（23.93%，95%CI：22.61 - 25.30%；NAMCS为18.40%，95%CI：15.62 - 21.54%）。两项调查均报告“全功能”系统的使用比例较低（HTPS为7.84%，95%CI：7.03 - 8.73%；NAMCS为4.56%，95%CI：3.09 - 6.68%），但HTPS中“基本”系统的使用比例远高于NAMCS（22.29%对11.16%）。通过多变量分析，我们在两项调查中发现了共同的医生或执业特征，尽管估计效应的大小有所不同。总之，两项调查中门诊医生对“全功能”EHR系统的使用比例都较低。对医生来说，尤其是小型诊所的医生，在未来两年采用并实现“有意义的使用”可能是一项艰巨的任务。
