Browsing by Author "Bates, David W."

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    Assessment of Satisfaction With the Electronic Health Record Among Physicians in Physician-Owned vs Non–Physician-Owned Practices
    (American Medical Association, 2022-04-01) Rotenstein, Lisa S.; Apathy, Nate; Landon, Bruce; Bates, David W.; Health Policy and Management, Richard M. Fairbanks School of Public Health
    Importance: Despite known benefits, electronic health records (EHRs) have had drawbacks for daily practice and the physician experience. There is evidence that physicians practicing in solo or physician-owned practices are more likely to be satisfied with the EHR and experience lower burnout than those practicing in other ownership arrangements; however, it is unclear how practice ownership patterns interact with physicians' experiences with the EHR and documentation in the EHR now that use of these systems is widespread. Objective: To examine the association between practice ownership and physician perceptions of the EHR. Design, setting, and participants: This cross-sectional study included non-federally employed physicians who provided office-based patient care in 2019 and completed the 2019 National Electronic Health Records Survey. The 2019 survey sample consisted of 1524 eligible responses (41.0% unweighted response rate representing 301 603 physicians); of those, 1368 physicians who reported having an EHR and answered questions regarding location ownership were included in the analysis. Data for the 2019 National Electronic Health Records Survey were collected by RTI International from June 14 to December 11, 2019; the current cross-sectional analysis was conducted from October 1 to November 30, 2021. Main outcomes and measures: Satisfaction with the EHR, perceptions of time spent on clinical documentation, and presence of staff support for documentation. Results: Among 1368 respondents (weighted, 270 813 respondents) included in the analysis, 960 respondents (weighted: 185,385 respondents [68.5%]) were male, and 951 respondents (weighted: 200,622 respondents [74.1%]) were over 50 years of age; 766 respondents (weighted, 161 226 respondents [59.5%]) were working in a practice owned by a physician or physician group, and 700 respondents (weighted, 131 284 respondents [48.5%]) were primary care physicians. A total of 602 respondents (weighted, 109 587 physicians [40.5%]) were working in a non-physician-owned practice. Overall, 529 respondents (weighted, 108 093 respondents [68.1%]) working in physician-owned practices reported being satisfied with their EHR vs 320 respondents (weighted, 63 988 respondents [58.5%]) working in non-physician-owned practices (P = .03). Among those working in physician-owned practices, perceptions that time spent on documentation was appropriate (328 physicians [weighted, 71 827 physicians (44.8%)] vs 191 physicians [weighted, 35 447 physicians (32.4%)]; P = .005) and that staff support for documentation was available (289 physicians [weighted, 57 702 physicians (36.0%)] vs 146 physicians [weighted, 29 267 physicians (26.7%)]; P = .02) were significantly higher compared with those working in non-physician-owned practices. Physicians' perceptions of the appropriateness of time spent and the availability of staff support only partially explained the association between practice ownership type and EHR satisfaction. Conclusions and relevance: The results of this nationally representative cross-sectional study suggest that physicians working in physician-owned practices are more likely to be satisfied with the EHR, to have positive perceptions of time spent on documentation, and to have staff support for documentation compared with their counterparts working in non-physician-owned practices. The workflow and cultural forces underlying these differences are important to understand in the setting of known differences in burnout by practice ownership type and ongoing physician group consolidation and acquisition by health care systems.
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    A Consensus Action Agenda for Achieving the National Health Information Infrastructure
    (Oxford University Press, 2004) Yasnoff, William A.; Humphreys, Betsy L.; Overhage, J. Marc; Detmer, Don E.; Brennan, Patricia Flatley; Morris, Richard W.; Middleton, Blackford; Bates, David W.; Fanning, John P.; Medicine, School of Medicine
    BACKGROUND: Improving the safety, quality, and efficiency of health care will require immediate and ubiquitous access to complete patient information and decision support provided through a National Health Information Infrastructure (NHII). METHODS: To help define the action steps needed to achieve an NHII, the U.S. Department of Health and Human Services sponsored a national consensus conference in July 2003. RESULTS: Attendees favored a public-private coordination group to guide NHII activities, provide education, share resources, and monitor relevant metrics to mark progress. They identified financial incentives, health information standards, and overcoming a few important legal obstacles as key NHII enablers. Community and regional implementation projects, including consumer access to a personal health record, were seen as necessary to demonstrate comprehensive functional systems that can serve as models for the entire nation. Finally, the participants identified the need for increased funding for research on the impact of health information technology on patient safety and quality of care. Individuals, organizations, and federal agencies are using these consensus recommendations to guide NHII efforts.