Correlates of electronic health record adoption in office practices: a statewide survey

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This paper describes the adoption and correlates to adoption of electronic health records in office practices within the state of Massachusetts during the 2005 time period.


To determine the factors that lead to adoption of EHR in office practices in a single state.


Eight page mailed survey to a stratified random sample of all office medical practices in the state of Massachusetts. A single physician in each practice was randomly selected to respond. The initial mailing included a $20 dollar cash honorarium. Non responders received additional mailings without additional honoraria and ultimately and astounding response rate of 71% was obtained. The study had 80% power to detect a 10% difference in adoption rates of EHR based on practice type, size, geographic location and hospital affiliation. Because the stratified random sample did not adequately represent all practices within the state, sampling weights were used to more adequately represent the practices.


Forty five percent of the physicians had an EHR which represented 23% of the practices in the state. The use of EHRs varied by practice size with 52% of practices with at least 7 physicians having EHRs. EHRs were also more frequent in hospital based practices and those in teaching institutions. Using logistic regression, the strongest correlate of adoption of EHRs was practice size (OR 3.66 for practices of 7 or more). Other correlates included hospital based practices (OR 2.44) and those associated with teaching (OR 2.3). Not correlated with EHRs were practice type and geographic location. Practices that reported active involvement in quality of care initiatives and those more likely to use email, electronic scheduling and e-prescribing were more likely to have EHRs. The only barrier to EHR adoption reported by at least 50% of the physicians was start up cost.


The major findings of this study were a higher than expected adoption of EHRs in the state of Massachusetts compared to previous reports in the literature from other areas of the country. In addition, larger hospital based practices associated with teaching were more likely to have adopted EHRs. The findings do not seem too surprising considering the location of the study; a state with several high profile teaching institutions many of which have been on the forefront of the development of EHRs. The use of sampling weights to adjust the data may also have contributed to some of the findings since it is not clear that this technique is an adequate way to adjust for the fact that the sample was biased to large, hospital based practices.

2nd Review

This is a review of Simon, S. R., Kaushal, R., Cleary, P. D., Jenter, C. A., Volk, L. A., Poon, E. G., Orav, E. J., Lo, H. G., Williams, D.H. & Bates, D. W. (2007). Correlates of electronic health record adoption in office practices: a statewide survey [1]


Electronic health records (EHRs) in spite of showing great promise to improve efficiency, costs and patient safety still are not being implemented at rates that would be expected. Simon et al., (2007) in this paper hopes to identify some the correlates of EHR implementation. One of those factors or potentially perceived barriers examined was concerns of security with implementing EHRs.


The authors used a database from a private vendor in addition to data from the Massachusetts Board of Registration in Medicine to locate doctors from many specialties practicing in the state. They narrowed down the sample to exclude physicians who were retired, still in training or not directly involved in patient care. The clinicians chosen were eventually randomly picked from different practices. The questionnaire used included such items as size of your practice, internet availability and financial resources of the practice.


The authors received back 1345 completed surveys which represented about 71% of those sent out. Using logistic regression analyses, it was determined that the size of the practice was the most robust correlate of EHR implementation. Incentives to adopt EHRs was another strong determining factor; high startup costs was cited as a deterrent to EHR implementation. Security concerns were voiced by 58% of practices that had not adopted an EHR and 47% of those that had implemented EHR systems. This translates to a finding that the majority of clinicians see security issues as being an obstacle to welcoming EHRs into their daily routine.


It can be concluded that although the main identifiable barriers to EHR implementation are practice size, financial resources and affiliation with an institution of higher learning the concern of security breach is on many clinician’s radar. Over half of them in this study expressed the fear of not being able to protect their patients’ health information. This article was an interesting read; it is also very informative as it lists many factors believed to be influential to physicians when considering the implementation of EHRs.


  1. Simon, S. R., Kaushal, R., Cleary, P. D., Jenter, C. A., Volk, L. A., Poon, E. G., Orav, E. J., Lo, H. G., Williams, D.H. & Bates, D. W. (2007). Correlates of electronic health record adoption in office practices: a statewide survey.