Variation in Clinical Information Technology (IT) Across Physician Specialties

Lack of Clinically Relevant IT Products Targeted Toward Specialists May Hinder Adoption

Data Bulletin No. 34
Sept. 20, 2007

Alwyn Cassil (202) 264-3484 or

WASHINGTON, DC—While practice setting and size are the strongest predictors of physicians’ access to clinical information technology (IT) in their practices, significant variation in IT adoption exists across specialties, according to a national study released today by the Center for Studying Health System Change (HSC).

"Clinical IT has the potential to improve coordination of care and support quality improvement and reporting activities, but this study makes it clear that there’s wide variation across physician specialties and that may hinder progress in harnessing IT to improve care," said Paul B. Ginsburg, president of HSC, a nonpartisan policy research organization funded primarily by the Robert Wood Johnson Foundation

The study examined whether physicians had access to information technology in their practices for the following five clinical activities: Obtaining information about treatment alternatives or recommended guidelines; accessing patient notes, medication lists or problem lists; writing prescriptions; exchanging clinical data and images with other physicians; and exchanging clinical data and images with hospitals. Physicians with access to IT for all five clinical activities were considered to have an electronic medical record (EMR).

Across primary care, medical and surgical specialties, significant variation in access to IT exists. Surgeons lagged medical specialists in access to IT for four of the five clinical activities—obtaining guidelines, accessing patient notes, writing prescriptions, and exchanging clinical data with other physicians, according to the study. Surgeons also were less likely to have all five clinical activities associated with an EMR. Primary care physicians lagged medical specialists in IT access for two activities, accessing notes and exchanging data with other physicians.

Based on HSC’s nationally representative 2004-05 Community Tracking Study Physician Survey, the study’s findings are detailed in a new HSC Data Bulletin—Clinical Information Technology Adoption Varies Across Physician Specialties—available here. The 2004-05 survey contains responses from more than 6,600 physicians and had a 52 percent response rate.

Differences in IT access among subspecialties were even greater, particularly for medical subspecialists. Psychiatrists were substantially less likely than the comparison group of other medical subspecialists to access IT for all activities, except writing prescriptions. In contrast, oncologists were much more likely than the comparison group to have access to IT for guidelines and exchanging data with hospitals and physicians.

Among surgical subspecialists, ophthalmologists lagged the comparison group of general surgeons and other surgical subspecialists for all activities but obtaining guidelines. Obstetricians/gynecologists were less likely than the comparison group to access notes and exchange data with physicians or hospitals. Among primary care physicians, the major difference was that pediatricians and general and family physicians were less likely than internists to access IT for patient notes.

"The importance of particular clinical activities to a specialty may affect IT adoption across physician specialties," said HSC Health Research Analyst Catherine Corey, M.S.P.H, coauthor of the study with HSC Senior Researcher Joy M. Grossman, Ph.D. "For example, surgeons may have less need for IT to write prescriptions since they typically prescribe a narrow range of on-formulary medications on a short-term basis in contrast to medical specialists and PCPs who treat chronically ill patients taking multiple medications."

In other cases, existing EMR products may not meet the distinct clinical needs of some specialties, such as enhanced drawing features and imaging storage for ophthalmologists monitoring glaucoma patients or growth tracking capabilities and pediatric dosing calculations for pediatricians.

The study cautioned that the findings be considered an upper bound on the proportion of physicians regularly using clinical information technology 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.