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Prevalence and Functionality of Electronic Health Records in Internal Medicine Continuity Clinics

Reddy, Siddharta G. MPH; Babbott, Stewart F. MD; Beasley, Brent W. MD; Nadkarni, Mohan M. MD; Gertner, Eric J. MD, MPH; Holmboe, Eric S. MD

doi: 10.1097/ACM.0b013e3181df1903
Technology and Medicine

Purpose Health information technology (HIT), particularly electronic health records (EHRs), will become universal in ambulatory practices, but the current roles and functions that HIT and EHRs play in the ambulatory clinic settings of internal medicine (IM) residents are unknown.

Method The authors conducted a Web-based survey from July 2007 to January 2008 to ascertain HIT prevalence and functionality. Respondents were directors of one or more ambulatory clinics where IM residents completed any required outpatient training, as identified by directors of accredited U.S. IM residencies.

Results The authors identified 356 clinic directors from 264 accredited U.S. programs (70%); 221 directors (62%) completed the survey, representing 185 accredited programs (49%). According to responding directors, residents in 121 of 216 clinics (56%) had access to EHRs, residents in 147 of 219 clinics (67%) used some type of electronic data system (EDS) to manage patient information, and residents in 62 clinics (28% of 219 responding) used an EDS to generate lists of patients needing follow-up care. Compared with smaller IM training programs, programs with ≥50 trainees were more likely to have an EDS (67% versus 53%, P = .037), electronic prescription writer (57% versus 42%, P = .026), or EHR (63% versus 45%, P = .007).

Conclusions Resident ambulatory clinics seem to have greater adoption of HIT and EHRs than practicing physicians' ambulatory offices. Ample room for improvement exists, however, as electronic systems with suboptimal patient data, limited functionality, and reliance on multiple (paper and electronic) systems all hinder residents' ability to perform important care coordination activities.

Mr. Reddy is research associate, Quality Research, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Dr. Babbott is associate professor, Department of General Medicine, University of Kansas Medical Center, Kansas City, Kansas.

Dr. Beasley is associate professor of medicine, University of Missouri Kansas City School of Medicine, University of Missouri Kansas City, Kansas City, Missouri.

Dr. Nadkarni is associate professor of internal medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia.

Dr. Gertner is associate professor of clinical medicine, Penn State College of Medicine, Department of Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania.

Dr. Holmboe is senior vice president and chief medical officer, American Board of Internal Medicine, Philadelphia, Pennsylvania.

Correspondence should be addressed to Mr. Reddy, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; telephone: (215) 606-4140; fax: (215) 399-4085; e-mail:

First published online May 6, 2010

© 2010 Association of American Medical Colleges