BACKGROUND: The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act created meaningful use (MU) incentive program to promote the nationwide adoption of certified electronic health record (EHR) systems. Computerized physician order entry (CPOE) system is a part of the EHR system and a cornerstone of the MU incentive program, which helps to reduce prescribing errors and enhance care coordination for treatment between providers.
OBJECTIVES: The main objective of this study was to investigate trends in the adoption of CPOE system for medication orders and determine factors associated with meeting the meaningful use criteria for health information technology.
METHODS: A cross-sectional analysis was conducted using 10 years of data from the 2006–2015 National Ambulatory Medical Care Survey (NAMCS), 10 years of 2006–2015 data from the National Hospital Ambulatory Medical Care Survey (NHAMCS)—emergency department (ED) component, the 2016 American Hospital Association (AHA) Annual Survey Database, and the 2016 AHA Annual Survey Information Technology (IT) Supplement. The outcomes of the study included the adoption of CPOE for medication orders, drug-drug interaction alerts (DDI), guideline reminders, electronic prescribing (eRx), health information exchange (HIE), and compliance with the MU criteria. Descriptive statistics were calculated for all study variables. Bivariate analysis using the chi-square test was used to determine if there is a significant relationship between the adoption of CPOE for medication orders and timing (pre-post meaningful use). Chi-square test for trend was used to determine the significance of the change in the adoption of several EHR functionalities between 2006 and 2015. Logistic regression analyses were performed to identify factors that influence the adoption of several EHR functionalities. All analyses were performed using SAS 9.3 at an alpha of 0.05.
RESULTS: In NAMCS 2006–2015, the weighted surveyed physicians’ responses were weighted to represent 325,070 ambulatory based physicians throughout the U.S. The majority (66%) of respondents worked in group practices, and 34% worked as solo practitioners. The overall AHA annual survey sample had 6,239 hospitals. Of these, a total of 3,656 hospitals responded to the AHA IT supplement survey, representing a response rate of 59%. Primary care physicians’ adoption of CPOE systems for medication orders was significantly higher than specialists (p < 0.0001). The adoption of CPOE for medication orders was higher in the Post-MU incentive payments period (2012–2015) compared to pre-MU incentive payments period (2006–2011) in both the ambulatory care and ED settings (p < 0.0001). From 2006 through 2015 there was a statistically significant increase in the percent of ambulatory care practices adopting CPOE medication ordering system with clinical decision support (CDS) tools and eRx in the ambulatory care setting (p-trend < 0.001). In the same period, group practices compared to solo practices were significantly more likely to adopt these EHR functionalities (p < 0.0001). From 2013 to 2015, physician offices that generated > 50% of their revenue from Medicaid in the ambulatory care setting were less likely to adopt EHR systems that meet the MU criteria compared those generate ≤ 50% (p < 0.01).
CONCLUSION: Findings indicate that physician specialty, practice size, and percentage of revenue from Medicaid are significantly associated with the adoption of selected EHR functionalities. The CPOE for medication orders adoption rates significantly increased post-MU incentive payments. No significant association was found between for-profit hospitals and sending electronic notification to the patient’s primary care physician upon ED visit. These results may be important to design interventions to improve EHR adoption.
|Advisor:||Maneno, Mary K.|
|Commitee:||Ettienne, Earl B., Gabriel, Meghan H., Huang, Sean S., Maneno, Mary K., Wingate, La'Marcus T.|
|School Location:||United States -- District of Columbia|
|Source:||DAI-B 80/07(E), Dissertation Abstracts International|
|Subjects:||Information Technology, Pharmaceutical sciences|
|Keywords:||Computerized physician order entry system, Electronic health records, Health information exchange, Health information technology adoption, Incentive payments program, Meaningful use|
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