Predictors of Health IT Adoption in Small Primary Care Practices

The use of health information technology (IT) in small primary care practices continues to rise, but a recent study found that the extent of health IT adoption varies based on practice size, ownership, and financial incentives. The research highlights the need for strategies that provide targeted assistance to practices that might struggle with health IT implementation.

In recent years, federal initiatives like the Health Information Technology for Economic and Clinical Health (HITECH) Act and CMS’ Electronic Health Record (EHR) Incentive Program have attempted to encourage adoption of health IT, but disparities in utilization persist nonetheless. Previous research has demonstrated that in practices with less than 20 physicians, health IT use “was associated with larger size, primary care specialty, and pay-for-performance incentives.”

This longitudinal study, published in the Annals of Family Medicine, surveyed 566 primary care groups with 8 or fewer physicians. The hypothesis based on prior literature was that practices would be more likely to adopt and use HIT if they had external incentives for change and the internal capabilities to respond to those incentives, like larger practice size and ownership by a hospital or healthcare system.

Researchers conducted the first wave of surveys from 2007 to 2010, and the second from 2012 to 2013. In that time, the proportion of practices reporting that they used all paper medical records and no EHRs dropped by half, from 66.8% to 32.3%. The mean health IT summary index, a variable indicating the number of positive responses to 18 questions on usage of individual health IT components, increased from 4.7 to 7.3, indicating that the practices had implemented an average of 2.6 additional functionalities in this time.

Utilization rates decreased for just 2 of these 18 individual measures, electronic access to laboratory results and electronic access to clinical information on patient visits to the emergency department. For the remaining functionalities, significant gains were observed over time. For instance, the initial survey saw just 25% of practices report that they digitally transmitted prescriptions directly to pharmacies, but by the follow-up 70% of the cohort said they did so. In the second wave of the study, 19% of practices allowed patients to view their medical record online, a substantial increase from the meager 1% of practices that offered this functionality during the first survey period.

The researchers then performed analyses to test for the effects of practice size, ownership, and external incentives on the likelihood of health IT utilization. As they had hypothesized, the practices owned by hospitals instead of physicians had higher mean health IT indexes at both survey points, and practices with 3 to 8 physicians scored higher than practices with 1 or 2 doctors. They also found that greater health IT adoption was associated with external incentives, defined as participation in pay-for-performance programs, participation in public reporting of clinical quality data, and greater proportion of revenue from Medicare, which would indicate exposure to the CMS EHR Incentive Program.

Regression analyses with time as a predictor yielded similar estimates, implying that these predictive factors “continue to differentiate practices even when the general upward trend in health IT index scores is factored out,” the authors wrote.

Despite the gains in health IT adoption between the 2 surveys, the process was far from completed by the end of the study period. The researchers identified several areas with room for improvement, like the use of e-mail or online medical records to communicate with patients, which just one-fifth of the practices did at the time of the follow-up survey. They emphasized that utilizing health IT to its full potential will be essential for small practices fighting to succeed under new payment paradigms.

“The majority of primary care practices in the United States are small, and many have taken on the enormous challenge of transforming how they deliver care,” the authors wrote. “Implementation and meaningful use of health IT serves as an important aspect of practice transformation and a foundational element for high-performing primary care.”