Physician Capability to Electronically Exchange Clinical Information, 2011 | Page 2
Published Online: October 23, 2013
Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD
We used multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics, including EHR adoption and state fixed effects to control for confounding within each state. Given the dichotomous nature of the dependent variables, we estimated probit regression models and used the regression results to calculate the incremental effects associated with each independent variable (all were categorical variables). These incremental effects represent the percentage point change in the outcome that is associated with a given characteristic (compared with a reference category). Analyses were conducted using Stata 12.0 (StataCorp, College Station, Texas). We used weights to account for nonresponse and standard errors, which were adjusted to account for the complex sample design.
We assessed the extent to which exchange capability varied by vendor. We only included vendors that had at least 1% of the market share (representing a total of 55% of physicians with EHRs). Vendors with at least 1% of the market share included the following: Allscripts, Cerner, eClinicalWorks, Epic, eMDs, GE/Centricity, Greenway Medical, NextGen, and Sage.
Physicians’ capability to electronically exchange clinical data varied by type of information (Figure 1). More than half of all physicians (55%) reported that their practices have computerized capability to e-prescribe. A majority of physicians (67%) reported that they are able to view lab results electronically, but fewer physicians (42%) were able to incorporate lab results into their EHR. More than one-third (35%) reported they are able to send lab orders electronically. The computerized capability to provide clinical summaries to patients was reported by 38% of physicians.
Among those physicians who reported exchanging clinical summaries with other providers (31%), approximately three-fourths (76%) reported both sending and receiving clinical summaries (eAppendix B, available at www.ajmc.com). About one-fifth (19%) of physicians reported that they send clinical summaries only to other providers. Of all physicians who exchange clinical summaries with other providers (eAppendix C, available at www.ajmc.com), the most common method of access was through an EHR vendor (64%), followed by a hospital-based system (28%).
Physicians’ capability to exchange varies by EHR adoption status (Figure 1). A large majority of physicians with an EHR have the capability to send prescriptions electronically (78%) and view lab results electronically (87%). Substantial minorities of physicians with no EHR also have these capabilities (23% and 42%, respectively), highlighting the role that stand-alone e-prescribing products and proprietary portals continue to play in facilitating physician access to pharmacy and lab result data. However, very few physicians without an EHR have the capability to electronically exchange clinical summaries and lab orders.
Physician Exchange Capability by State
Physicians’ capability to exchange clinical information widely varies by state (eAppendix D, available at www.ajmc.com). The capability to receive lab results electronically ranged from 88% (Wisconsin) to 44% (Louisiana). The capability to then incorporate those results electronically into an EHR among those providers able to receive results electronically varied between 73% (Minnesota) and 21% (Louisiana). Electronic lab ordering ranged from 58% (Washington) to 19% (Delaware). The capacity to electronically exchange clinical summaries with patients varied from 55% (Minnesota) to 18% (Louisiana). The proportion of physicians who exchange clinical summaries with other providers varied from 61% (Wisconsin) to 15% (Alabama).
Although the rates vary widely across states, physicians in certain states exchange these data at consistently higher or lower rates compared with the national average (Figure 2). Physicians in 7 states reported the capability to exchange clinical information at rates significantly higher than the national average across at least 4 out of the 6 measures of exchange: Massachusetts, Minnesota, North Dakota, Oregon, Vermont, Wisconsin, and Washington. Conversely, Louisiana, Nevada, and New Jersey have significantly lower rates of physician reported exchange capability across at least 4 out of the 6 measures.
Physician and Practice Characteristics Associated With Exchange Capability
Practice Characteristics. Although a number of practice characteristics were significantly associated with physicians’ capability to exchange different types of clinical information (Table), the single strongest significant predictor was adoption of an EHR (P <.001). Adjusting for other physician and practice characteristics, physicians with an EHR were 49 percentage points more likely to have computerized capability to provide clinical summaries to patients and 37 percentage points more likely to exchange clinical summaries with other providers compared with physicians with no EHR. The association between EHR adoption and the capability to exchange pharmacy data and lab data were similarly strong.
Practice ownership was also an important predictor of exchange capability. Practices owned by health maintenance organizations or healthcare corporations were significantly more likely to exchange all 6 types of clinical data compared with physician-owned or physician group–owned practices. Community health centers were significantly less likely to have the capability to e-prescribe (P <.001) or receive lab results electronically (P <.05) compared with physician-owned or physician group–owned practices. Practices owned by hospitals or academic medical centers were significantly less likely to have the capability to e-prescribe (P <.001) but more likely to have the capability to receive lab results electronically (P <.001) and exchange clinical summaries with other providers (P <.001).
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