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Geographic Variation in Ambulatory Electronic Health Record Adoption: Implications for Underserved Communities
Author(s) -
King Jennifer,
Furukawa Michael F.,
Buntin Melinda B.
Publication year - 2013
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12078
Subject(s) - microdata (statistics) , metropolitan area , population , lagging , american community survey , geography , medicine , public health , health care , business , environmental health , census , economic growth , nursing , pathology , economics , archaeology
Objective To describe small area variation in ambulatory electronic health record ( EHR ) adoption and assess evidence of a “digital divide” in whether adoption is lagging in traditionally underserved communities. Data Sources Survey data on U.S. ambulatory health care sites (261,973 sites representing 716,160 providers) collected by SK&A Information Services in 2011. Study Design We examined cross‐sectional variation in two measures of local area EHR adoption: share of providers at sites using an EHR with e‐prescribing functionality; and predicted probability of EHR adoption for the average site. Local areas were defined as Public Use Microdata Areas ( n = 2,068). Using multivariate regression, we examined the association between adoption and three area characteristics: high concentration of minority population; high concentration of low‐income population; and metropolitan status. Principal Findings EHR adoption varied significantly across local areas, ranging from 8 to 88 percent with a median of 41 percent. Adoption was lower in large metropolitan areas; areas with high concentration of minority population in the Northeast and West; and areas with high concentration of low‐income population in the Midwest. Conclusions Our 2011 estimates suggest there was substantial room for increased EHR adoption across the United States, including some underserved areas with relatively low EHR adoption rates. Further research should monitor policy initiatives in these areas and examine sources of heterogeneity in low‐ and high‐adoption communities.