Methods

1. Size Matters: Factors Associated with Availability of Electronic Health Records in California Physicians’ Practices Janet M .Coffman, MPP, PhD, Kevin Grumbach, MD, Margaret Fix, MPH, Leon Traister, Andrew Bindman, MD University of California, San Francisco, School of Medicine Institute for Health Policy Studies Conclusions Methods Background Dependent Variables • The odds of EHR availability increase monotonically with practice size. • Specialists, rural MDs, and MDs with ≥30% Medicaidhave lower odds of having an EHR. The HITECH Act authorizes Medicare and Medicaid to make incentive payments to clinicians and hospitals for meaningful use of EHRs. Information about the factors associated with EHR availability can assist CMS, state Medicaid agencies, and the Regional Extension Centers in targeting outreach regarding incentive payments. • Explanatory Variable • Age (<46 yrs., 46-65 yrs., >65 yrs.) • Gender • Major specialty (primary care vs. specialist) • Location (urban vs. rural) • ≥30% Medicaid, SCHIP, and/or uninsured • Setting (office-based vs. hospital-based) • Size (solo, 2-9 MDs, 10-49 MDs, 50+ MDs) • Statistical Analysis • Multivariable logistic regression Limitations • Self-reported data • Some responses were incomplete (14% missing data on payers and/or practice settings) • MDs may not be familiar with all of the features of their EHRs • Only assessed MDs; findings may not generalize to other clinicians Objective To identify factors associated with having any sort of EHR and an EHR with basic or advanced functions. Study Design Results* Written survey of a sample of physicians (MDs) who renewed their medical licenses through the Medical Board of California in June and July 2011. Responses were submitted by mail or online. Survey data were combined with information from other databases maintained by the Medical Board. The analysis was limited to MDs who practice in California and provide at least 1 hour of patient care per week. The response rate among these MDs was 68% (n = 5,384). Implications • The lower odds of EHR availability in practices with high percentages of Medicaid patient suggest that the Medicaid incentive program targets practices that would benefit from assistance. • Outreach efforts for both the Medicaid and Medicare incentive programs should be targeted to specialists, rural practices, and solo and small practices. * Results are similar if residents/fellows and physicians working less than 20 hours per week are excluded. Sources of Funding: California Department of Health Care Services and the California HealthCare Foundation