Electronic Thesis/Dissertation


Adoption of Electronic Health Records and Associated Impact on Quality in Primary Care Open Access

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Background: The national priority to accelerate the adoption of electronic health records (EHR) among health care providers in the US is based on its potential to improve quality of care. This study assessed the adoption of EHRs in primary care, a setting that is essential to maintaining the individual and community health, and whether adoption was associated with improvements in quality. Methods: The study was a cross-sectional analysis of primary care visits from the 2007-2012 National Ambulatory Medical Care Survey. Using definitions of “basic” and “advanced” EHR systems based on previous expert consensus, the study determined the proportion of primary care practices using the systems, the factors associated with adoption, and the relationship between EHRs and the delivery of services -- colorectal cancer screening and advanced imaging for head pain -- with known quality problems.Results: About one in five practices had advanced EHRs and 10.83% had basic EHRs. Over the study period, the rate of increase of advanced EHRs exceeded that of basic EHRs, particularly after 2009. Multivariate logistic regressions showed certain patient and practice characteristics such as age and practice ownership predicted colonoscopy and head CTs; however, EHRs did not have a strong relationship with the procedures. Conclusions and implications: Despite increases in adoption, EHRs were not associated with the two quality indicators of interest. This study does not support previous assertions that EHRs would inherently improve care and health. EHRs, however, are still a tool necessary to address persistent problems with poor-quality care. Future efforts should focus on aligning EHR systems with clinical care delivery, especially on the usability of the systems.

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