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The New Tech Disparity

Why is there more technology in your pocket than at your doctor’s office?

Electronic health record (EHR) systems are poised to become the backbone of future healthcare delivery in the United States. For over a decade, EHR systems have been touted as the solution to improving efficiency in medical practices and the panacea for the reduction of medical errors. The government has recognized EHR systems and health information technology (IT) implementation as a national priority. Modernizing the country’s health IT backbone and improving physician adoption of EHR systems has been the main goal of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

Source: Saad Faruque (Flickr/CC)

Source: Saad Faruque (Flickr/CC)

A new study published in Health Affairs examined the impact HITECH had on physician adoption rates of EHR systems, and what differences exist in adoption rates within key physician and practice demographics. This study utilized data from surveys conducted by the Centers for Disease Control (CDC) between 2009-2013.

The researchers found that in 2013, 78% of office-based physicians had adopted some aspects of an EHR system in their clinical practice. However, when asked whether specific functions were included in their EHR systems—like recording patient history, clinical notes, or even reviewing laboratory results—only 48% of office-based physicians answered in the affirmative. Although 48% appears to be a low number, the researchers note that it is .

A close examination of physician specialty breakdown showed the rate of EHR adoption among primary care physicians was 53% compared to 43% of specialists (p <0.001). Not surprisingly, data suggest that the larger the group practice (i.e. six or more physicians) the higher the likelihood of EHR adoption compared to solo practitioners.

Differences were also found in clinical geographic location, with as much as 53.5% of physicians in the Midwest utilizing an EHR system.

Though EHR use will continue to increase nationally, a closer look at adoption patterns show disparities not only among solo practitioners and physician specialists, but even in the broad category of geographic location. Non-adopters have cited cost and as barriers to EHR adoption. In addition to these perceived barriers, there are some recent studies that are questioning the initial promise that EHRs would improve patient quality of care.

One of the upcoming priorities of HITECH will be a push to have EHR systems communicate between physician offices, specialists, and patients. Before any positive gains can be made within that arena, however, we must address the concerns of the large proportion of physicians and practices that have not implemented any form of EHR and promote the improvement of those with meager functionality. Otherwise, we may inadvertently create a new disparity in the American health care system.

commentary by Nii Darko, DO, MBA


The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others. Physicians’ electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention. PMID: 25104827

Furukawa, MF, et al. Health Affairs 2014; 33 (9) : 1672-9.

Nii Darko, DO, MBA
About Nii Darko, DO, MBA

Dr. Darko is a board-certified general surgeon who currently practices in Pennsylvania. He began writing for Policy Prescriptions® in 2012. Contact: Facebook | Twitter | More Posts