Background: A major factor limiting efficiency and quality gains from clinical information technologies is the lack of full use by the clinicians.
Purpose: To identify the practice and physician characteristics that influence the use of e-scripts after adoption.
Methods: Data were obtained from 27 primary care medical group practices that had e-script technology for 2 years. Physician and practice characteristics were obtained from the clinics, and the proportion of each physician's prescriptions sent electronically was calculated from the prescription records. Practice culture data were obtained from a survey of the physicians in each practice. Data were analyzed using hierarchal regression.
Findings: Practice-level variables explain most of the variance in the use of e-scripts by physicians, although there are significant differences in use among specialties as well. General internists have slightly lower use rates and pediatricians have the highest rates. Larger practices and multispecialty practices have higher use rates, and five practice culture dimensions influence these rates; two have a negative influence and three (organizational trust, adaptive, and a business orientation) have a positive influence.
Practice Implications: While previous studies have identified physician characteristics and product deficiencies as factors limiting the use of electronic information technologies in medical practices, our data indicate that the influence of these factors may be highly dependent on the culture of the practice. Consequently, practice administrators can improve physician acceptance and use of these technologies by making sure that there is a culture/technology fit before deciding on a product.
John E. Kralewski, PhD, is Professor, Division of Health Policy and Management, University of Minnesota, Minneapolis. E-mail: krale001@umn.
Bryan E. Dowd, PhD, is Professor, Division of Health Policy and Management, University of Minnesota, Minneapolis.
Titilope Cole-Adeniyi, BA, is Research Assistant, Division of Health Policy and Management, University of Minnesota, Minneapolis.
Dave Gans, MSHA, FACMPE, is Vice President, Practice Management Resources, Medical Group Management Association, Engelwood, Colorado.
Lucy Malakar, MA, is Instructor, Lorain County Community College, Cleveland, Ohio.
Bob Elson, MD, MS, is Senior Researcher Clinical Informatics, MetroHealth Center for Health Care Research and Policy, MetroHealth Medical Center, Cleveland, Ohio.