Electronic Health Record Use Can Vary by Race

Newswise — A push for widespread use of electronic health records (EHRs) has become a central part of the national health care debate, but a new study shows that the technology is not equally available to American patients.

Your own doctor's use of EHRs mostly depends on whether she practices alone or as part of a group or clinic, with group practitioners more likely to adopt the new technology, the researchers found.

But researchers Esther Hing and Catharine Burt also uncovered differences in EHR adoption among the doctors who treat underserved minorities, which they report in the May issue of the Journal of Health Care for the Poor and Underserved.

The National Center for Health Statistics researchers found that uninsured African-American and Latino patients, and Latino Medicaid patients were less likely to have a doctor using electronic records than privately insured white patients, even after controlling for the doctors' type of practice.

Many believe electronic health records will reduce prescribing errors, help physicians determine the best standard of care for conditions and better coordinate care of patients between doctors, but if the new record system is adopted unevenly, Hing said, "The benefits of this new technology may not be available to the underserved."

Hing and Burt used national surveys from 2005 to 2006, which included an estimated 150 million patients and 500 million visits to primary care physicians, to look at EHR adoption across the country. For the purposes of the study, researchers considered doctors who could order prescriptions and tests electronically and view test results and clinical notes electronically to be EHR adopters.

During those years, only one in every eight patients had a primary care physician who used EHRs, the researchers discovered. Patients in urban areas were more likely than those in rural areas were to visit a doctor who used electronic records.

However, the physician's practice type connected most closely to his or her use of EHRs. Doctors in group practice, community health clinics and hospital outpatient departments were more likely to use EHRs than physicians in solo or partner practices, according Hing and Burt. To the extent that community health clinics are more frequently visited by racial/ethnic minority group members, this makes the disparities more striking.

Physicians for poor minority patients "were a mixture of high and low EHR adopters," said Hing, who added that "efforts to narrow disparities in health care are lost" when doctors who treat minority patients do not use EHRs.

In a 2008 Harvard School of Public Health study of Massachusetts physicians, researchers concluded that physicians serving minority patients in the state were just as likely as their colleagues to adopt EHRs for their practices. "We failed to find evidence of a new digital divide," said Ashish Jha, M.D., the Harvard professor who led the study.

Journal of Health Care for the Poor and Underserved: Contact Editor Virginia M. Brennan at (615) 327-6819 or [email protected]. Online, visit http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/

Hing E, Burt CW. Are there patient disparities when electronic health records are adopted? Journal of Health Care for the Poor and Underserved 20(2), 2009.