Summary
Background: The federal government is promoting adoption of electronic health records (EHRs)
through financial incentives for EHR use and implementation support provided by regional
extension centers. Small practices have been slow to adopt EHRs.
Objectives: Our objective was to measure time to EHR implementation and identify factors associated
with successful implementation in small practices receiving financial incentives and
implementation support. This study is unique in exploiting quantitative implementation
time data collected prospectively as part of routine project management.
Methods: This mixed-methods study includes interviews of key informants and a cohort study
of 544 practices that had worked with the Primary Care Information Project (PCIP),
a publicly funded organization that since 2007 has subsidized EHRs and provided implementation
support similar to that supplied by the new regional extension centers. Data from
a project management database were used for a cohort study to assess time to implementation
and predictors of implementation success.
Results: Four hundred and thirty practices (79%) implemented EHRs within the analysis period,
with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated
with implementation success were: fewer providers, practice sites, and patients; fewer
Medicaid and uninsured patients; having previous experience with scheduling software;
enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice
management product rather than two products. Interviews identified positive attitude
toward EHRs, resources, and centralized leadership as additional practice-level predictors
of success.
Conclusions: A local initiative similar to current federal programs successfully implemented EHRs
in primary care practices by offsetting software costs and providing implementation
assistance. Nevertheless, implementation success was affected by practice size and
other characteristics, suggesting that the federal programs can reduce barriers to
EHR implementation but may not eliminate them.
Citation: Ancker JS, Singh MP, Thomas R, Edwards A, Snyder A, Kashyap A, Kaushal R. Predictors
of success for electronic health record implementation in small physician practices.
Appl Clin Inf 2013; 4: 12–24
http://dx.doi.org/10.4338/ACI-2012-09-RA-0033
Keywords
Electronic health records - ambulatory care/primary care - implementation and deployment
- facilitators and barriers - quantitative methods - mixed methods
