JMIR Publications

ABSTRACT

Background:

Electronic health record (EHR) systems are generally associated with improvements in care processes, quality of care, and patient outcomes. Yet, the adoption of EHR in substance use disorder (SUD) treatment programs remains limited.

Objective:

This paper describes the adoption of EHR in SUDs, with a focus on changes in adoption from 2014 to 2017; and identification of factors associated with adoption. We examine the extent to which characteristics of SUDs, including prior technology use, program, client and geographical location are associated with adoption of EHR.

Methods:

We used data from the latest available waves of the National Drug Abuse Treatment System Survey (NDATSS), completed in 2014 and 2017, to examine rate of EHR adoption in SUDs, and correlates of adoption. Our analysis included 1,027 SUDs with complete data (n=531 in 2014 and n=496 in 2017). We used descriptive statistics to assess changes in EHR adoption and program characteristics between 2014 and 2017. We then conducted bivariate analyses, using chi-square test and t-test for categorical and continuous variables, respectively. We conducted multivariate logistic regressions to examine associations between the independent variables and EHR adoption.

Results:

Our results show statistically significant differences in EHR adoption in SUD treatment programs between 2014 and 2017. While adoption increased over time, nearly one-third SUD programs had not yet adopted an EHR system by 2017. Adoption increased from 57.6 percent in 2014 to 69.2 percent in 2017 (p<.05). Three major barriers, including startup costs, ongoing financial cost, and privacy or security concerns (p<0.001 for each barrier), were significantly associated with reasons why programs had not begun or expanded use of an EHR. We found that current use of technology such as computerized scheduling (AOR=3.02, 95% CI=2.23 to 4.09), and billing systems (AOR=2.29, 95%CI=1.62 to 3.25), private not-for-profit (AOR=1.86, 95%CI=1.31 to 2.65), public ownership (AOR= 2.14, 95%CI=1.27 to 3.67) or, and participation in a patient centered medical home (AOR=1.93, 95%CI=1.29 to 2.92) were positively associated with EHR adoption.

Conclusions:

Our findings suggest that SUD programs are on track to achieve widespread EHR adoption. There is however a need for focused strategies and related policies to effectively tackle barriers impeding programs that have yet to adopt EHR, as well as obstacles to expanding use of EHR systems. The persistent cost and financing-related barriers necessitate the need for incentives models that are more aligned with and facilitate higher adoption and implementation of EHR. Clinical Trial: Not applicable.