Annals of Family Medicine

Small Primary Care Practices Make Gains in Health IT Adoption, Use

January 25, 2017 01:10 pm News Staff

A recent study( published in the January/February issue of Annals of Family Medicine indicates that adoption and use of health information technology (HIT) by small primary care practices increased between two specific time frames: 2007-2010 and 2012-2013.

Furthermore, authors of the study -- "Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study" -- noted that external incentives, such as those received by practices through pay-for-performance programs and through their participation in public reporting of clinical quality data, were associated with an uptick in meaningful use of HIT.

These findings are encouraging given the AAFP's decade-long focus on helping family physicians implement and optimize use of their electronic health record (EHR) systems.

To that point, in a 2014 interview with AAFP News, Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation, said this: "Physicians want their EHR systems to, at a minimum, do one of three things: Save them time, eliminate hassles or increase revenue."

Story Highlights
  • New research published in Annals of Family Medicine indicates that small primary care practices have made gains in adopting and using health information technology (IT).
  • Researchers concluded that participation in pay-for-performance incentives and participation in public reporting of clinical quality data were associated with greater adoption and use of health IT.
  • A larger proportion of practice revenue from Medicare also was associated with greater uptake of health IT.

He acknowledged that HIT products had not yet achieved optimal levels of usability and interoperability, but said, "Our goal is to give family physicians the tools, techniques and concepts that will empower them to evaluate and improve their practices with health IT."


For their research, authors conducted two national surveys: the National Study of Small and Medium-Sized Physician Practices (2007-2010) and the Third National Study of Physician Organizations (2012-2013).

For each study, 40-minute interviews were conducted with lead physicians or practice administrators in nationally representative samples of physician practices and medical groups.

The surveys focused on practices that treated patients with four major chronic illnesses: asthma, coronary heart disease, depression and diabetes. The analytic sample for the longitudinal cohort study included practices that had eight or fewer physicians, at least half of whom practiced primary care medicine (i.e., family physicians, general internists and general practitioners).

The 566 practices that ultimately were part of the cohort group participated in both of the researchers' national surveys.


Researchers noted that the majority of the 566 practices were, at the start of the study period, solo or two-physician offices that were physician-owned, but trended over time to grow larger and/or to come under hospital ownership. Specifically, between survey one (2007-2010) and survey two (2012-2013),

  • physician-owned practices decreased from 90.6 percent to 86.8 percent,
  • hospital-owned practices increased from 9.4 percent to 13.3 percent,
  • pay-for-performance participation increased from 52.5 percent to 59 percent, and
  • public reporting by practices increased from 40.8 percent to 54.6 percent.

Authors reported an increase in 16 measures of HIT adoption and use for the 566 small primary care practices between 2007-2010 and 2012-2013. For instance, physician use of an EHR increased for the following functions:

  • electronic prescribing (from 25 percent to 70 percent),
  • notifying physicians of potential drug interactions (17 percent to 46 percent),
  • collecting data for quality measures (17 percent to 42 percent),
  • creating progress notes (26 percent to 51 percent),
  • storing patient medication lists (29 percent to 51 percent),
  • creating a patient problem list (28 percent to 47 percent) and
  • allowing patients to view medical records online (1 percent to 19 percent).

Use of electronic registries within practices increased for all four chronic diseases, with the biggest increases -- 10 percent each -- occurring for asthma and diabetes.

"The proportion of practices that relied on paper records dropped precipitously during this period, and functionalities such as e-prescribing, email with patients, and use of an EHR to collect clinical quality data increased substantially," wrote the authors.

After controlling for other factors, researchers concluded that "participation in pay-for-performance incentives and participation in public reporting of clinical quality data were associated with greater adoption and use of HIT.

"A larger proportion of practice revenue from Medicare was also independently associated with greater HIT uptake," they said.

Finally, authors identified areas for improvement. For instance, they noted that fewer than 50 percent of practices used most of the EHR functionalities available to them, and only one in five practices used email with patients or let patients view their medical record online.

Researchers also pointed out that despite increases in the use of disease registries, "Maintenance of electronic registries for the management of chronic disease was also low for all practices."

"The majority of primary care practices in the United States are small, and many have taken on the enormous challenge of transforming how they delivery care," wrote the authors.

"Implementation and meaningful use of HIT serves as an important aspect of practice transformation and a foundational element for high-performing primary care."