Center for Studying Health System Change

Clinical IT Gaps Persist—Grow—Between Small and Large Physician Practices

News Release
Nov. 9, 2006

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Physicians in smaller practices continue to lag well behind physicians in larger practices in reporting the availability of clinical information technology (IT) in their offices, according to a national study released today by the Center for Studying Health System Change (HSC).

The proportion of physicians reporting access to IT for each of five clinical activities increased across all practice settings between 2000-01 and 2004-05. However, adoption gaps between small and large practices persisted for two of the clinical activities—obtaining treatment guidelines and exchanging clinical data with other physicians—and widened for the other three—accessing patient notes, generating preventive care reminders and writing prescriptions, according to the study funded by the Robert Wood Johnson Foundation.

In the case of access to IT to write prescriptions, the adoption gap between small (1-9 physicians) and large (51-plus physicians) group practices tripled between 2000-01 and 2004-05, the study found. In 2000-01, 8 percent of physicians in small group practices reported access to IT to write prescriptions, with the proportion growing to 13 percent in 2004-05. In contrast, 19 percent of physicians in large group practices reported access to IT to write prescriptions in 2000-01, but the proportion grew to 47 percent by 2004-05.

"Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind," said Joy M. Grossman, Ph.D., co-author of the study and senior health researcher at HSC, a nonpartisan policy research organization funded primarily by The Robert Wood Johnson Foundation.

"The differences may reflect a natural path of technology adoption where larger, savvier organizations adopt new technologies first and others follow, albeit at a slower rate," Grossman said. "Or it may be that smaller practices face different and substantial barriers that affect how quickly they catch up, if ever."

Based on HSC’s nationally representative Community Tracking Study Physician Survey, the study’s findings are detailed in a new HSC Issue Brief—Clinical Information Technology Gaps Persist Among Physicians—available here. The 2000-01 survey contains information on about 12,000 physicians and had a 59 percent response rate, and the 2004-05 survey includes information from more than 6,600 physicians and had a 52 percent response rate.

The study also found physicians in practices treating more underserved and vulnerable patients—low-income, minority or rural patients and those with chronic conditions—generally were no less likely to report access to IT in their practices than other physicians.

For example, physicians in practices with the highest proportions of Medicaid revenue—greater than 25 percent of total practice revenue—were as likely or more likely as other physicians to report IT for each of the clinical activities, regardless of practice size. Access to IT was lower than average, however, for physicians practicing in community health centers for two of the five clinical activities—exchanging clinical data and accessing patient notes—likely highlighting the importance of financial barriers to IT adoption for these two clinical activities.

Physicians in practices with the highest proportions of patients with chronic conditions and minority patients were as likely or more likely to report having access to IT for all five clinical activities in 2004-05.

The study cautioned that the findings should be considered an upper bound on the proportion of physicians regularly using clinical IT in their practices because physicians were asked about IT availability in their practice but not whether they actually use the technology or the frequency or intensity of use.

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The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.