Perceptions of Electronic Health Record Implementation: A Statewide Survey of Physicians in Rhode Island



      Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience.


      We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice.


      The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction.


      We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time.


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        • Blumenthal D.
        Wiring the health system–origins and provisions of a new federal program.
        N Engl J Med. 2011; 365: 2323-2329
        • Reed M.
        • Huang J.
        • Graetz I.
        • et al.
        Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
        Ann Intern Med. 2012; 157: 482-489
        • Reed M.
        • Huang J.
        • Brand R.
        • et al.
        Implementation of an outpatient electronic health record and emergency department visits, hospitalizations, and office visits among patients with diabetes.
        JAMA. 2013; 310: 1060-1065
        • Adler-Milstein J.
        • Salzberg C.
        • Franz C.
        • Orav E.J.
        • Newhouse J.P.
        • Bates D.W.
        Effect of electronic health records on health care costs: longitudinal comparative evidence from community practices.
        Ann Intern Med. 2013; 159: 97-104
        • Jarvis B.
        • Johnson T.
        • Butler P.
        • et al.
        Assessing the impact of electronic health records as an enabler of hospital quality and patient satisfaction.
        Acad Med. 2013; 88: 1471-1477
        • Friedberg M.W.
        • Coltin K.L.
        • Safran D.G.
        • Dresser M.
        • Zaslavsky A.M.
        • Schneider E.C.
        Associations between structural capabilities of primary care practices and performance on selected quality measures.
        Acad Med. 2009; 151: 456-463
        • Baier R.R.
        • Gardner R.L.
        • Buechner J.S.
        • Harris Y.
        • Viner-Brown S.
        • Gifford D.S.
        Creating a survey to assess physicians' adoption of health information technology.
        Med Care Res Rev. 2012; 69: 231-245
        • TAAfPO
        Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys.
        American Association for Public Opinion Research, Deerfield, IL2011
        • Baier R.
        • Buechner J.
        • Gifford D.
        • Harris Y.
        • Gardner R.
        The Adoption and Use of Health Information Technology (HIT) by Rhode Island Physicians, 2009.
        Med Health R I. 2010; 93: 89-90
        • Baier R.
        • Voss R.
        • Morphis B.
        • Viner-Brown S.
        • Gardner R.
        Rhode Island Physicians' Health Information Technology (HIT) Use, 2009-2011.
        Med Health R I. 2011; 94: 215-217
        • Jamoom E.
        • Beatty P.
        • Bercovitz A.
        • Woodwell D.
        • Palso K.
        • Rechtsteiner E.
        Physician adoption of electronic health record systems: United States, 2011.
        NCHS Data Brief. 2012; : 1-8
        • Archer N.
        • Cocosila M.
        A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.
        J Med Internet Res. 2011; 13: e57
        • Menachemi N.
        • Powers T.L.
        • Brooks R.G.
        The role of information technology usage in physician practice satisfaction.
        Health Care Manage Rev. 2009; 34: 364-371
        • Wright E.
        • Marvel J.
        Electronic health records: postadoption physician satisfaction and continued use.
        Health Care Manag (Frederick). 2012; 31: 259-267
        • Edsall R.L.
        • Adler K.G.
        The 2012 EHR User Satisfaction Survey: responses from 3,088 family physicians.
        Fam Pract Manag. 2012; 19: 23-30
        • Heyworth L.
        • Zhang F.
        • Jenter C.A.
        • et al.
        Physician satisfaction following electronic health record adoption in three Massachusetts communities.
        Interact J Med Res. 2012; 1: e12
        • Vishwanath A.
        • Singh S.R.
        • Winkelstein P.
        The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects.
        Int J Med Inform. 2010; 79: 778-791
        • Makam A.N.
        • Lanham H.J.
        • Batchelor K.
        • et al.
        The good, the bad and the early adopters: providers' attitudes about a common, commercial EHR.
        J Eval Clin Pract. 2014; 20: 36-42
        • Irani J.S.
        • Middleton J.L.
        • Marfatia R.
        • Omana E.T.
        • D'Amico F.
        The use of electronic health records in the exam room and patient satisfaction: a systematic review.
        J Am Board Fam Med. 2009; 22: 553-562
        • Menachemi N.
        • Powers T.L.
        • Brooks R.G.
        Physician and practice characteristics associated with longitudinal increases in electronic health records adoption.
        J Healthc Manag. 2011; 56: 183-198
        • Ferris T.G.
        • Johnson S.A.
        • Co J.P.
        • et al.
        Electronic results management in pediatric ambulatory care: qualitative assessment.
        Pediatrics. 2009; 123: S85-S91
        • Duffy R.L.
        • Yiu S.S.
        • Molokhia E.
        • Walker R.
        • Perkins R.A.
        Effects of electronic prescribing on the clinical practice of a family medicine residency.
        Fam Med. 2010; 42: 358-363
        • Rosen P.
        • Spalding S.J.
        • Hannon M.J.
        • Boudreau R.M.
        • Kwoh C.K.
        Parent satisfaction with the electronic medical record in an academic pediatric rheumatology practice.
        J Med Internet Res. 2011; 13: e40