Overall, 163 physicians completed both surveys in 2005 and 2009. Among these physicians, 156 physicians (96%) answered questions relating to our main outcome. The physicians were mostly men, and most had full or partial ownership stake in their practice (see ). Most participants (70%) had been in practice for at least 15 years, with a median of 22 years since graduation from medical school. A total of 22 physicians (15%) reported having a ‘solo’ practice; 99 physicians (63%) indicated that they practised in a primary care or single specialty group practice and 35 (22%) worked in multispecialty group practices. A total of 26 physicians (17%) indicated that their practice had at least moderate resources for expansion or improvements of any kind; only two physicians (1%) stated that their practice had extensive resources for expansion. The mean EHR usage score was 0.68 (SD=0.28).
Overall, 54 physicians (35%) reported that the implementation process for their EHR was very difficult. Eighty-four (54%) of the physicians found the process to be somewhat difficult; only 18 (12%) reported their implementation process was not difficult.
Factors associated with difficulty of EHR implementation in bivariate analyses are shown in . Compared with physicians who were partial or full owners of their practice, those without any ownership stake in their practice were less likely to view the implementation process as difficult or very difficult (OR 0.5, 95% CI 0.2 to 0.9). In terms of absolute numbers, 26% of non-owners (14/54) indicated that implementation was very difficult, compared with 38% of owners (40/104).
The odds of finding the EHR implementation process difficult by physicians in ambulatory practices*
Physicians who indicated that the office staff was innovative were less likely to view the implementation process as difficult or very difficult (OR 0.4, 95% CI 0.2 to 0.8), compared with physicians who did not indicate that their staff was innovative. Higher EHR usage scores were associated with lower likelihood of viewing the implementation process as difficult or very difficult (OR 0.3, 95% CI 0.1 to 0.9).
In multivariate analysis, however, physicians' EHR usage score was not associated with the perceived difficulty of EHR implementation. Physicians who were employed by their practice (ie, those who did not have partial or full ownership stake in the practice) were less likely to view EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Similarly, physicians who perceived their staff as innovative were less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). We did not find evidence of effect modification by practice size on owners' perception of difficulty (p=0.69).