Physician specialty and variations in adoption of electronic health records

Appl Clin Inform. 2013 May 22;4(2):225-40. doi: 10.4338/ACI-2013-02-RA-0015. Print 2013.


Objective: Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored.

Methods: We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree).

Results: Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine/general practitioners. After adjustment for covariates, these specialties were 44-94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty.

Conclusions: Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties.

Keywords: Electronic health records; United States; ambulatory care; health policy; specialization.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analysis of Variance
  • Attitude to Computers*
  • Cross-Sectional Studies
  • Electronic Health Records / statistics & numerical data*
  • Humans
  • Medicine / statistics & numerical data*
  • Physicians / psychology
  • Physicians / statistics & numerical data*
  • Regression Analysis
  • Retrospective Studies
  • Time Factors