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Physicians' Use, Exchange, and Evaluation of Electronic Medical Records

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Physicians' Use, Exchange, and Evaluation of Electronic Medical Records PHYSICIANS’ USE, EXCHANGE, AND EVALUATION OF ELECTRONIC MEDICAL RECORDS September 2017 Sponsored by the Arizona Health Care Cost Containment System (AHCCCS) ISA Number YH14-0039 The Center for Health Information & Research (CHiR) is a multidisciplinary unit under the College of Health Solutions at Arizona State University. CHiR provides comprehensive health care information for Arizona and serves as a community resource and tool for academia and public health. CHiR is directed by George Runger, PhD, who is also Chair of the Department of Biomedical Informatics and Professor in the School of Computing, Informatics, and Decision Systems Engineering. For more information about CHiR’s current initiatives as well as downloadable publications, please visit our website or contact us via email. Project Team Professor & Founder of CHiR William G. Johnson, PhD [email protected] Senior Statistical Programmer Gevork Harootunian, MS(c) [email protected] Senior Coordinator Tameka Sama, MBA, CRA [email protected] Database Analyst Sruthi Kommareddy, MS [email protected] Acknowledgements The authors gratefully acknowledge the cooperation of Patricia McSorely, Executive Director of the Arizona Medical Board (AMB) and Jenna Jones, Executive Director of the Arizona Board of Osteopathic Examiners (ABOE). Thanks also to the invaluable assistance of the previous directors, Lisa Wynn of AMB and Elaine LeTarte of ABOE. The current and previous Directors have maintained a tradition of cooperation with the survey that began more than twenty years ago. Special thanks to James Gentile and Pushpa Gregory of the AMB for their excellent and enthusiastic technical support. Lorie Mayer, Health Information Technology Coordinator and Terry Magden, Senior HIT Project Manager, have been the most helpful and informed representatives of the sponsor, the Arizona Health Care Cost Containment System, throughout this project. CHiR- 502 E. Monroe St, Suite C320, Phoenix, AZ 85004 (602) 496-2009 | [email protected] | http://chs.asu.edu/chir 2 Table of Contents Executive Summary .................................................................................................................... 7 Introduction ................................................................................................................................. 9 Background ............................................................................................................................... 10 The CHiR Survey of Physicians ............................................................................................... 10 Definitions ............................................................................................................................... 12 Survey Sample ........................................................................................................................ 13 Non-Response Bias ................................................................................................................ 15 All Physician Results ................................................................................................................ 19 EMR Utilization ....................................................................................................................... 19 Utilization of EMR Functions ................................................................................................... 22 EMR Adoption Incentives ........................................................................................................ 26 Prevalence of EMR Replacement ........................................................................................... 28 Comparing AHCCCS to Non-AHCCCS Physicians ................................................................ 31 Practice Settings ..................................................................................................................... 31 Urban-Rural Distribution by AHCCCS and Non-AHCCCS Physicians ................................... 34 The Utilization of Electronic Medical Records ......................................................................... 35 Physicians’ Evaluation of EMR Software ................................................................................ 36 Summary & Conclusion ........................................................................................................... 47 References ................................................................................................................................. 49 Appendix A: Comparison to National Surveys ...................................................................... 55 Appendix B: CHiR Health Care Workforce Reports and Articles ......................................... 71 Appendix C: Survey Instrument (2012-2015) .......................................................................... 75 Appendix D: New Survey Instrument April 2015-March 2017 ............................................... 83 Appendix E: Evaluations of EMRs by Vendor ........................................................................ 91 Appendix F: EMR Software Descriptions ............................................................................... 97 3 Appendix G: All Physician Results ......................................................................................... 99 All Physician Characteristics ................................................................................................... 99 Practice Settings ................................................................................................................... 100 Characteristics of EMR Users ............................................................................................... 102 The Utilization of Electronic Medical Records ....................................................................... 103 A Multivariate Model of the Determinants of EMR Adoption & Information Exchange .......... 104 Utilization of EMR Functions ................................................................................................. 105 Utilization of EMRs by Vendor .............................................................................................. 106 Physicians’ Evaluation of EMR Software .............................................................................. 108 Installation/Replacement of EMRs ........................................................................................ 116 The Target Population .......................................................................................................... 120 Appendix H: AHCCCS Physician Results ............................................................................. 123 AHCCCS Physician Characteristics ...................................................................................... 123 Practice Settings of AHCCCS Physicians ............................................................................. 125 Characteristics of AHCCCS EMR Users ............................................................................... 127 The Utilization of Electronic Medical Records by AHCCCS Physicians ................................ 128 A Multivariate Model of the Determinants of EMR Adoption & Information Exchange .......... 129 Utilization of EMR Functions by AHCCCS Physicians .......................................................... 130 Utilization of EMRs by Vendor .............................................................................................. 131 AHCCCS Physicians’ Evaluation of EMR Software .............................................................. 133 Installation/Replacement of EMRs by AHCCCS Physicians ................................................. 141 The Target Population of AHCCCS Physicians .................................................................... 145 Appendix I: Non-AHCCCS Physician Results ...................................................................... 147 Non-AHCCCS Physician Characteristics .............................................................................. 147 Practice Settings ................................................................................................................... 149 Characteristics of Non-AHCCCS EMR Users ....................................................................... 151 The Utilization of Electronic Medical Records by Non-AHCCCS Physicians ........................ 152 4 Utilization of EMR Functions by Non-AHCCCS Physicians .................................................. 153 Utilization of EMRs by Vendor .............................................................................................. 154 Non-AHCCCS Physicians’ Evaluation of EMR Software ...................................................... 155 Installation/Replacement of EMRs by Non-AHCCCS Physicians ......................................... 164 The Target Population of Non-AHCCCS Physicians ............................................................ 167 5 6 Executive Summary • This report focuses on the use of Electronic Medical Records and their effects. Physicians who treat AHCCCS patients are compared to non-AHCCCS physicians. • The percentage of Arizona physicians using EMRs increased from approximately 45% in 2007-2009 to approximately 90% in 2015-2017. Solo practice physicians are, all else equal, much less likely to adopt EMRs than are physicians in other practice settings. The prevalence of solo practice is declining in Arizona, in part due to acquisitions of practices
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