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Local Public Health Department Adoption and Use of Electronic Health Records

McCullough, J. Mac PhD, MPH; Zimmerman, Frederick J. PhD; Bell, Douglas S. MD, PhD; Rodriguez, Hector P. PhD, MPH

Journal of Public Health Management and Practice: January/February 2015 - Volume 21 - Issue 1 - p E20–E28
doi: 10.1097/PHH.0000000000000143
Original Articles

Context: Electronic health records (EHRs) may help local health departments (LHDs) to improve services and thereby promote and protect population health. Yet, little is known about nationwide trends and correlates of EHR use by LHDs.

Objective: We examine relative contributions of LHD finances, leadership, and governance to EHR adoption and use from 2010 to 2013. The impact of LHD service provision and meaningful use factors on EHR use is explored in depth.

Design: Combining data from the National Association of County & City Health Officials Profile survey and the Area Health Resource File, logistic regression models were used to examine EHR use in 2013. Multinomial logistic models examined EHR adoption, use, or discontinuation from 2010 to 2013.

Participants: EHR usage data were available for 514 and 488 LHDs in 2010 and 2013, respectively. A total of 117 LHDs had data for both 2010 and 2013.

Main Outcome Measures: Outcomes included dichotomized measures of LHD self-reported use of EHRs in 2010 and 2013. For LHDs with 2 years of data, a 4-category variable measuring self-reported EHR use, nonuse, adoption, or discontinuation was analyzed.

Results: Overall LHD EHR use did not increase significantly between 2010 (19.3%) and 2013 (22.0%). While 15% of LHDs reported adopting EHRs from 2010 to 2013, another 8.5% reported discontinuing use of EHRs during this time. Likelihood of EHR use was strongly associated with LHD clinical service characteristics, per capita expenditures, and state governance structure.

Conclusions: EHRs do not appear to be rapidly diffusing across LHDs, and retention of current systems may be a concern. Given trends away from clinical service provision and other pressing demands for LHD resources, the benefits of EHR adoption are unclear.

Supplemental Digital Content is Available in the Text.This study examines electronic health record adoption and use of local health departments.

School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix (Dr McCullough); Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles (Dr Zimmerman); General Internal Medicine, Geffen School of Medicine, University of California, Los Angeles (Dr Bell); and Division of Health Policy & Management, School of Public Health, University of California, Berkeley, Berkeley, California (Dr Rodriguez).

Correspondence: J. Mac McCullough, PhD, MPH, School for the Science of Health Care Delivery, Arizona State University, 550 N 3rd St, Phoenix, AZ 85004 (

J.M.M. received funding in partial support of this work from the Graduate Division of the University of California, Los Angeles. The authors thank the valuable review and comment on a draft of the manuscript by Paul Torrens.

The authors do not have any competing interests or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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