Disparate access to electronic health records and quality reporting among US urologists
To measure performance and promote improvement in urology, physician leaders and organizations have bet heavily on electronic health record (EHR) technology. However, the logistics and cost of EHR may yield variable implementation. Accordingly, we examined contemporary patterns of use, hypothesizing that EHR and technology-based quality reporting would be less available to smaller, less resourced practices.
We analyzed data from the American Urological Association (AUA) Census, which assesses the urologic workforce and contains data on demographics, education/training, and practice. In 2014, the AUA Census queried urologists on the type of EHR used and plans for quality reporting. For this study, we classified the type of EHR used as none, basic, or certified (i.e., technology certified to meet the requirements of Meaningful Use) and assessed whether urologists planned to use an EHR for quality reporting. These outcomes were compared according to urologist characteristics using bivariable and multivariable analyses.
Among 2,204 urologists, 1,157 (52.5%) had a certified EHR, 878 (39.8%) had a basic EHR, and 169 (7.7%) reported no EHR. Overall, 655 (29.2%) planned to use an EHR for quality reporting with a higher proportion reported for those with basic vs. certified EHR (36.9 vs. 28.3%, p<0.001). On bivariable analysis, type of EHR and quality reporting differed with urologist age, gender, fellowship training, subspecialty, and work effort (p<0.05). Type of EHR varied substantially with practice setting (Figure) while EHR-based quality reporting ranged from 21.6% for urologists at academic medical centers to 38.6% for those in a urology group (p<0.001). Multivariable analysis showed size and type of practice (i.e., solo or single-specialty) to be significantly associated with having no or basic EHR (p<0.05). Urologists with higher work load of patient visits and work hours more often used basic EHRs and planned to use their EHR for quality reporting (p<0.05).</p>
In 2014, only a minority of urologists used a certified EHR and intended to leverage EHR technology for quality reporting. Large-scale efforts aiming to improve quality of care in urology using EHR technology will need to address practice disparities with particular focus on urologists in smaller, single-specialty practices.