Factors Influencing Family Physician Adoption of Electronic Health Records (EHRs)

Article Figures & Data

Table 1. Demographic Characteristics of Surveyed American Board of Family Medicine (ABFM) Candidates

Variable	2006 (n = 8192)	2007 (n = 9430)	2008 (n = 9597)	2009 (n = 9475)	2010 (n = 2412)	2011 (n = 2339)	Overall (n = 41,445)
Male sex^*	68.1	66.9	66.8	65.2	67.5	67.9	66.8
Age^* (mean)	47.5	47.9	48.6	49.5	51.3	51.3	48.7
<40	22.6	22.0	19.4	16.5	8.9	9.4	18.8
40–60	69.5	68.6	69.5	70.2	74.2	73.2	70.2
≥60	7.9	9.4	11.1	13.3	16.9	17.2	10.6
MD degree^*	92.8	92.6	92.2	92.1	90.1	90.0	92.2
International medical graduate^*	10.4	11.9	13.2	15.2	22.6	20.6	13.8
Type of organization^*
Administration	1.1	1.1	1.2	1.1	1.2	1.5	1.1
Educator	5.3	5.2	4.7	4.8	3.5	3.0	4.8
Government	5.8	6.3	6.9	6.7	7.3	6.9	6.6
Group	43.5	43.7	44.1	43.3	39.5	41.9	43.3
HMO	3.4	3.3	3.1	3.0	2.6	2.4	3.1
Independent (solo)	18.8	18.9	19.3	20.1	25.5	23.0	19.9
Partnership	13.2	12.7	11.7	11.3	10.3	10.2	12.0
Others	8.9	8.7	9.2	9.7	10.0	11.0	9.3
Rural^{^†}	19.6	18.4	18.9	18.4	16.2	16.9	18.5
Geographic HPSAs	7.0	6.7	6.9	7.2	7.4	7.1	7.0
MUA/P	22.3	21.0	21.2	21.6	21.6	22.7	21.6
Census region^*
Northeast	14.8	14.9	14.5	14.6	15.9	15.1	14.8
Midwest	27.2	26.8	26.6	25.9	25.5	25.9	26.5
South	33.6	33.5	34.5	34.2	35.7	37.1	34.2
West	24.3	24.8	24.4	25.4	22.8	21.9	24.5

Values are shown as percentages.
↵* P < .0001.
↵† P < .01.
HMO, health maintenance organization; HPSA, health professional shortage area; MUA/P, medically underserved area/population.

Table 2. EHR Adoption Rate By Physician/Practice Characteristics

Variable	2006	2007	2008	2009	2010	2011	Difference^*
National rate	36.9	42.9	49.1	54.3	57.4	68.0	31.1
Male sex	37.5	42.4	49.6	53.8	55.1	66.5	29.0
Age, years
<40	41.6	48.7	55.7	61.8	63.3	75.5	33.9
40–60	36.4	42.2	48.4	54.8	59.1	69.5	33.1
≥ 60	28.3	35.2	41.7	42.4	46.9	57.3	29.0
MD degree	37.1	43.0	49.1	54.6	57.5	68.1	31.0
International medical graduate	29.6	35.9	41.8	46.7	50.0	58.3	28.7
Type of organization
Administration	19.3	23.8	40.5	38.0	43.3	50.0	30.7
Educator	48.3	55.3	62.4	69.8	69.4	81.7	33.4
Government	56.9	60.9	62.8	69.5	76.1	82.0	25.1
Group	37.3	45.7	53.1	59.4	64.8	74.3	37.0
HMO	73.1	84.4	90.2	92.0	90.3	94.6	21.5
Independent (solo)	25.7	28.4	32.3	35.1	39.9	49.9	24.2
Partnership	35.4	37.6	46.0	53.4	56.5	71.1	35.7
Others	29.6	34.6	39.4	44.2	48.8	62.8	33.2
Rural	32.9	40.1	46.1	50.5	58.7	68.2	35.3
Geographic HPSAs	35.0	36.8	42.2	49.8	53.4	71.3	36.3
MUA/Ps	33.2	39.5	43.7	49.1	55.7	68.2	35.0
Census regions
Northeast	34.1	39.3	46.7	50.1	58.7	65.9	31.8
Midwest	36.4	42.0	49.3	53.9	53.2	67.8	31.4
South	34.0	40.1	45.9	51.7	57.3	67.7	33.7
West	43.3	49.9	54.8	60.7	61.2	70.0	26.7

Values are shown as percentages.
↵* The differences in adoption rates are between 2006 and 2011. All P < .0001 for trend.
EHR, electronic health records; HMO, health maintenance organization; HPSA, health professional shortage area; MUA/P, medically underserved area/population.

Table 3. Logistic Regression Odds Ratios of the Predictors of EHR Adoption (2006–2011)

Variable	Estimate	P	OR	95% CI
Intercept	0.6055	<.0001
Exam year (reference: 2006)
2007	0.2686	<.0001	1.308	1.228–1.394
2008	0.5634	<.0001	1.757	1.649–1.871
2009	0.8191	<.0001	2.269	2.129–2.417
2010	1.0624	<.0001	2.893	2.625–3.190
2011	1.5325	<.0001	4.630	4.177–5.131
Age^*	−0.0207	<.0001	0.980	0.977–0.982
Female (reference: male)	−0.1097	<.0001	0.896	0.857–0.938
IMG (reference: non-IMG)	−0.2286	<.0001	0.796	0.748–0.846
Type of organization	.	.	.	—
Administration	−0.7386	<.0001	0.478	0.391–0.584
Educator	0.4236	<.0001	1.527	1.386–1.684
Government	0.5666	<.0001	1.762	1.615–1.923
Group (reference)
HMO	1.7015	<.0001	5.482	4.657–6.454
Independent (solo)	−0.7655	<.0001	0.465	0.439–0.493
Partnership	−0.2633	<.0001	0.769	0.720–0.820
Others	−0.4771	<.0001	0.621	0.577–0.668
Rural (reference: urban)	−0.0147	.6061	0.985	0.932–1.042
Geographic-HPSAs (reference: non-Geographic HPSA)	−0.1010	.0191	0.904	0.831–0.984
MUA/P (reference: non-MUAP)	−0.1413	<.0001	0.868	0.822–0.917
Census region
Northeast (reference)	—	—	—	—
Midwest	−0.0168	.6186	0.983	0.920–1.051
South	−0.0134	.6848	0.987	0.925–1.053
West	0.1866	<.0001	1.205	1.126–1.290

Of the 41,445 total, 606 cases were excluded because of missing values in the independent variables.
↵* Age is treated as a continuous variable in the regression. Correct prediction is 67.5% with a 0.500 cut off (R² = 0.0927; maximum rescaled R² = 0.1236; P = .1722, Hosmer and Lemeshow goodness-of-fit test). EHR, electronic health records; HMO, health maintenance organization; HPSA, health professional shortage area; IMG, international medical graduates, MUA/P, medically underserved area/population.