JMIR Publications

ABSTRACT

Background:

Electronic health records (EHR) have been shown to be associated with improvements in care processes, quality of care, and patient outcomes. EHR also has a crucial role in the delivery of substance use disorder (SUD) treatment, and is considered important for addressing the substance use disorder crises, including the opioid epidemic. Yet, little is known about the adoption of EHR in SUDs treatment programs, and the internal and external organizational-level facilitators or barriers to the adoption of EHR in SUD treatment.

Objective:

This research examined the adoption of EHR in SUDs, with a focus on changes in adoption from 2014 to 2017, and identified organizational-level factors, and barriers associated with EHR adoption.

Methods:

We used data from the 2014 and 2017 National Drug Abuse Treatment System Survey (NDATSS). Our analysis included 1,027 (n=531 in 2014 and n=496 in 2017) SUDs. We used chi-square and Mann-Whitney U tests for categorical and continuous variables, respectively, to assess changes in EHR adoption, technology use, program, and client characteristics, by year. We also investigated differences in characteristics, and barriers to adoption, by EHR adoption status (adopted EHR vs. had not adopted or planning to adopt EHR). We then conducted multivariate logistic regressions to examine internal and external factors associated with EHR adoption.

Results:

We found that the adoption of EHR increased significantly from 57.6 percent in 2014 to 69.2 percent in 2017; but nearly one-third of SUD programs had not yet adopted an EHR system by 2017. We identified a significant increase in technology use, and ownership by a parent company, with a decrease in percent of uninsured patients in 2017, compared with 2014. Our analysis further identified significant differences for three major barriers: startup costs, ongoing financial cost, and privacy or security concerns and adoption. Programs that used computerized scheduling (adjusted odds ratio [AOR] 3.02, 95% CI=2.23 - 4.09), and billing systems (AOR 2.29, 95%CI 1.62 - 3.25) were more likely to adopt EHR. Similarly, ownership type, such as private not-for-profit (AOR 1.86, 95%CI 1.31 - 2.65), public (AOR 2.14, 95% CI 1.27 - 3.67), as well as interest in participating in a patient centered medical home (AOR 1.93, 95% CI 1.29 - 2.92) were associated with an increased likelihood to adopt EHR. Overall, SUDs were more likely to adopt an EHR system in 2017, compared with 2014 (AOR 1.44, 95% CI 1.07 1.94).

Conclusions:

Our findings demonstrated that SUD programs are on track to achieve widespread EHR adoption. However, there is a crucial need for focused strategies and policies, explicitly designed to systematically address barriers and tackle obstacles to expanding the adoption of EHR systems. These efforts must be holistic, and address internal and external factors at multiple organizational levels. Clinical Trial: Not applicable.