Electronic Order Entry Research Articles

Electronic Chemotherapy Order Entry: A Major Cancer Center's Implementation

Implementation of a computerized provider order entry system for complex chemotherapy regimens at a large cancer center required intense effort from a multidisciplinary team of clinical and systems experts with experience in all facets of the chemotherapy process. The online tools had to resemble the paper forms used at the time and parallel the successful established process as well as add new functionality. Close collaboration between the institution and the vendor was necessary. This article summarizes the institutional efforts, challenges, and collaborative processes that facilitated universal chemotherapy computerized electronic order entry across multiple sites during a period of several years.

Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period

A 2005 report from the Centers for Medicare and Medicaid Services and the Centers for Disease Control Surgical Infection Prevention program indicated that only 41% of prophylactic antibacterials were correctly stopped within 24 h of the end of surgery. Electronic order sets have shown promise as a means of integrating guideline information with electronic order entry systems and facilitating safer, more effective care. The aim was to study the effectiveness of a computer-based antibacterial order set on increasing the proportion of patients who have antibacterial wound prophylaxis discontinued in the appropriate time frame. The authors conducted a quasi-experimental interrupted time-series analysis over an 8-month study period with the implementation of a computer-based order system designed to prevent excessive duration of surgical prophylaxis antibacterials. The primary outcome was the proportion of surgeries with antibacterials discontinued in the appropriate time frame. Additionally, we evaluated the percent of surgeries after implementation of the electronic intervention with chart documentation of infection among surgeries where the prescriber indicated the reason for antibacterial therapy was treatment. The computer-based order intervention significantly improved the proportion of surgeries with timely discontinuation of antibacterials from 38.8% to 55.7% (p < 0.001) in the intervention hospital, while the control hospital remained at 56-57% (p = 0.006 for the difference between treated and control hospitals). In surgeries after intervention implementation where a prescriber indicated the reason for antibacterial therapy was treatment, the prevalence of chart documented infection was only 14%. A computer-based electronic order set intervention increased timely discontinuation of postoperative antibacterials.

Significant Reduction of Laboratory Specimen Labeling Errors by Implementation of an Electronic Ordering System Paired With a Bar-Code Specimen Labeling Process

We measure the rate of emergency department (ED) specimen processing error reduction after implementation of an electronic physician order entry system paired with a bar-coded specimen labeling process. A cohort pre- and postintervention study was conducted in the ED during a 61-month period ending September 2008 in a large urban teaching hospital. Historically, laboratory order and requisition processing was done by hand. Interventions included implementing an ED-specific electronic documentation and information system, which included physician order entry with patient verification through bar-coded wristbands and bar-coded specimen labels. The main outcome measure was processing error rate, defined as unlabeled/mislabeled/wrong patient specimen or requisition. Pre- and postimplementation data were tabulated monthly and compared in aggregate by χ(2) test. The contribution of ED error to total institution specimen error was also calculated. Of the 724,465 specimens collected preintervention, 3,007 (0.42%) were recorded as errors versus 379 errors (0.11%) of 334,039 specimens collected postintervention, which represents a 74% relative and 0.31% absolute decrease (95% confidence interval 0.28% to 0.32%). The proportion of institutional errors contributed by the ED was reduced from 20.4% to 11.4%, a 44% relative and 9.0% absolute reduction (95% confidence interval 7.7% to 10.3%). Subanalysis revealed that the majority of continued errors occur when the physician order entry/bar-code system could not be used (eg, blood bank or surgical pathology specimens). Combining an electronic physician order entry with bar-coded patient verification and electronic documentation and information system-generated specimen labels can significantly reduce ED specimen-related errors, with sizable influence on institutional specimen-related errors. Continued use of hand labeling and processing for special specimens appears inadvisable, though the cost-effectiveness of this intervention has not been established.

A qualitative analysis of Emergency Department physicians' practices and perceptions in relation to test result follow-up.

Follow-up of abnormal test results for discharged Emergency Department (ED) patients is a critical safety issue. This study aimed to explore ED physicians' perceptions, practices, and suggestions for improvements of test result follow-up when using an electronic provider order entry system to order all laboratory and radiology tests and view results. Interviews were conducted with seven ED physicians and one clinical information system support person. Interviews were analyzed to elicit key concepts relating to physicians' perceptions of test result follow-up and how the process could be improved. Results described the current electronic test result follow-up system with two paper-based manual back-up systems for microbiology and radiology results. The key issues for physicians were: responsibility for test follow-up; the unique ED environment and time pressures, and the role of the family physician in test result follow-up. The key suggestion for improvement was a complete integrated electronic information system with on-line result endorsement. The study highlighted the complexity of the test result follow-up process and the importance of engaging clinicians in devising solutions for improvements.

Web‐Based Training in Geriatrics for Medical Residents: A Randomized Controlled Trial Using Standardized Patients to Assess Outcomes

Although Web-based instruction offers an advantageous approach to medical education, few studies have addressed the use of Web-based education to teach clinical content at the postgraduate level. Even fewer studies have addressed clinical outcomes after the Web-based instruction, yet postgraduate training requirements now focus on outcomes of training. A randomized trial was conducted to compare knowledge of postgraduate year (PGY) 1 residents after Web-based with that after paper-based instruction and to compare residents' clinical application of their instruction using unannounced standardized patients (SPs) and unannounced activated standardized patients (ASPs). PGY 1 residents were assigned to a month-long ambulatory rotation during which they were randomized as a block to Web- or paper-based instruction covering the same four geriatric syndromes (dementia, depression, falls, and urinary incontinence). Outcome measures were mean change scores for before and after testing and scores from SP and ASP clinical encounter forms (checklist, chart abstraction, and electronic order entry). Residents who completed the Web-based instruction showed significantly greater improvement on the knowledge tests than those who received paper-based instruction. There were no significant differences in the scores from the SP and ASP clinical encounters except that the chart abstraction score was better for Web-based group than the paper-based group for dementia. Web-based instruction is an educational tool that medical residents readily accept and can be used to improve knowledge of core geriatrics content as measured using immediate posttesting. More-intensive educational interventions are needed to improve clinical performance by trainees in the care of older patients.

Analysis of Appropriateness of Outpatient CT and MRI Referred From Primary Care Clinics at an Academic Medical Center: How Critical Is the Need for Improved Decision Support?

The aim of this study was to retrospectively analyze a large group of CT and MRI examinations for appropriateness using evidence-based guidelines. The authors reviewed medical records from 459 elective outpatient CT and MR examinations from primary care physicians. Evidence-based appropriateness criteria from a radiology benefit management company were used to determine if the examination would have met criteria for approval. Submitted clinical history at the time of interpretation and clinic notes and laboratory results preceding the date of the imaging study were examined to simulate a real-time consultation with the referring provider. The radiology reports and subsequent clinic visits were analyzed for outcomes. Of the 459 examinations reviewed, 284 (62%) were CT and 175 (38%) were MRI. Three hundred forty-one (74%) were considered appropriate, and 118 (26%) were not considered appropriate. Examples of inappropriate examinations included brain CT for chronic headache, lumbar spine MR for acute back pain, knee or shoulder MRI in patients with osteoarthritis, and CT for hematuria during a urinary tract infection. Fifty-eight percent of the appropriate studies had positive results and affected subsequent management, whereas only thirteen percent [corrected] of inappropriate studies had positive results and affected management. A high percentage of examinations not meeting appropriateness criteria and subsequently yielding negative results suggests a need for tools to help primary care physicians improve the quality of their imaging decision requests. In the current environment, which stresses cost containment and comparative effectiveness, traditional radiology benefit management tools are being challenged by clinical decision support, with an emphasis on provider education coupled with electronic order entry systems.

Stopping the Hemorrhage

Aggressive management of high-risk non–ST-elevation acute coronary syndrome patients has focused on reducing ischemic complications with potent medications and mechanical interventions1,2 but at the cost of increased rates of major bleeding and associated adverse outcomes.3,4 The American College of Cardiology/American Heart Association 2007 guidelines for management of patients with unstable angina/non–ST-elevation myocardial infarction (NSTEMI)1 stress the importance of balancing antithrombotic and interventional therapies with therapeutic risk, and they urge special attention in groups at high bleeding risk, including women, the elderly, and those with renal insufficiency. For risk-prone groups, careful selection and dose adjustment of antithrombotics is encouraged, but no specific instruction for calculating bleeding risk or modifying treatment is provided. Article p 1873 The European Society of Cardiology’s 2007 guidelines for the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes2 also recognize and devote a special section to bleeding complications, covering predictors of bleeding risk, the impact of bleeding on prognosis, the management of bleeding complications, and the impact of blood transfusions on outcomes. Major bleeding has been reported in 2% to 8% of non–ST-elevation acute coronary syndrome patients, with higher rates noted in broad-based registries (as in CRUSADE: Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines) than in controlled clinical trials. Complicating therapeutic decision making is the observation that baseline predictors of bleeding, ie, old age, female sex, renal dysfunction, and baseline anemia, also predict the risk of death due to ischemic complications. The impact of bleeding on prognosis is increasingly recognized. Major bleeding in the Global Registry of Acute Coronary Events (GRACE) was significantly associated with in-hospital death (adjusted OR 1.645). In registries and trials of more than 30 000 patients, major bleeding was associated with a 4-fold increase in the …

Reducing Hyperglycemia Hospitalwide: The Basal-Bolus Concept

Hyperglycemia has been identified as potent and independent risk factor for adverse outcomes for patients. An initiative was undertaken to reduce hyperglycemia hospitalwide in adults. In a multistep process, insulin protocols were implemented hospitalwide via an electronic provider order entry system. Education regarding basal bolus insulin delivery preceded implementation. Protocols were modified in an ongoing manner on the basis of clinical staff feedback and blood glucose monitoring. Key practice changes included intravenous insulin for initial management in ICU patients, insulin replacement based on the basal bolus approach, elimination of sliding-scale insulin, standardization of blood glucose monitoring before meals, adjustment of prandial dose insulin based on food consumed, administration of prandial dose after the meal, evening snacks ordered based on insulin type, and a glycosolated hemoglobin (A1C) determination for patients with admission glucose > 180 mg/dL. Median inpatient glucose levels in patients with diabetes were assessed using statistical process control methodology. Between January 2004 and September 2007, median glucose for all inpatients with diabetes decreased 15% from 159 mg/dL to < 135 mg/dL. The percentage of inpatients with diabetes who experienced a day with a glucose measurement above 180 mg/dl decreased from 66% to 53%. Frequency of hypoglycemia (< 60 mg/dL) did not change following protocol implementation. Major improvements in hospitalwide blood glucose control are feasible and safe, employing standard protocols based on the basal-bolus concept. Improvement was sustained during a four-year period with ongoing institutional support, multidisciplinary education, collaboration between clinical services, and monitoring of clinical outcomes on a quarterly basis.

Recurrent CT, Cumulative Radiation Exposure, and Associated Radiation-induced Cancer Risks from CT of Adults

To estimate cumulative radiation exposure and lifetime attributable risk (LAR) of radiation-induced cancer from computed tomographic (CT) scanning of adult patients at a tertiary care academic medical center. This HIPAA-compliant study was approved by the institutional review board with waiver of informed consent. The cohort comprised 31,462 patients who underwent diagnostic CT in 2007 and had undergone 190,712 CT examinations over the prior 22 years. Each patient's cumulative CT radiation exposure was estimated by summing typical CT effective doses, and the Biological Effects of Ionizing Radiation (BEIR) VII methodology was used to estimate LAR on the basis of sex and age at each exposure. Billing ICD9 codes and electronic order entry information were used to stratify patients with LAR greater than 1%. Thirty-three percent of patients underwent five or more lifetime CT examinations, and 5% underwent between 22 and 132 examinations. Fifteen percent received estimated cumulative effective doses of more than 100 mSv, and 4% received between 250 and 1375 mSv. Associated LAR had mean and maximum values of 0.3% and 12% for cancer incidence and 0.2% and 6.8% for cancer mortality, respectively. CT exposures were estimated to produce 0.7% of total expected baseline cancer incidence and 1% of total cancer mortality. Seven percent of the cohort had estimated LAR greater than 1%, of which 40% had either no malignancy history or a cancer history without evidence of residual disease. Cumulative CT radiation exposure added incrementally to baseline cancer risk in the cohort. While most patients accrue low radiation-induced cancer risks, a subgroup is potentially at higher risk due to recurrent CT imaging.

Automatic referral to cardiac rehabilitation.

The pervasive negative impact of cardiovascular disease in the United States is well documented. Although advances have been made, the campaign to reduce the occurrence, progression, and mortality continues. Determining evidence-based data is only half the battle. Implementing new and updated clinical guidelines into daily practice is a challenging task. Cardiac rehabilitation is an example of a proven intervention whose benefit is hindered through erratic implementation. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), the American College of Cardiology (ACC), and the American Heart Association (AHA) have responded to this problem by publishing the AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services. This new national guideline recommends automatic referral to cardiac rehabilitation for every eligible patient (performance measure A-1). This article offers guidance for the initiation of an automatic referral system, including individualizing your protocol with regard to electronic or paper-based order entry structures.

Survey of information technology in Intensive Care Units in Ontario, Canada

BackgroundThe Intensive Care Unit (ICU) is a data-rich environment where information technology (IT) may enhance patient care. We surveyed ICUs in the province of Ontario, Canada, to determine the availability, implementation and variability of information systems.MethodsA self-administered internet-based survey was completed by ICU directors between May and October 2006. We measured the spectrum of ICU clinical data accessible electronically, the availability of decision support tools, the availability of electronic imaging systems for radiology, the use of electronic order entry and medication administration systems, and the availability of hardware and wireless or mobile systems. We used Fisher's Exact tests to compare IT availability and Classification and Regression Trees (CART) to estimate the optimal cut-point for the number of computers per ICU bed.ResultsWe obtained responses from 50 hospitals (68.5% of institutions with level 3 ICUs), of which 21 (42%) were university-affiliated. The majority electronically accessed laboratory data and imaging reports (92%) and used picture archiving and communication systems (PACS) (76%). Other computing functions were less prevalent (medication administration records 46%, physician or nursing notes 26%; medication order entry 22%). No association was noted between IT availability and ICU size or university affiliation. Sites used clinical information systems from15 different vendors and 8 different PACS systems were in use. Half of the respondents described the number of computers available as insufficient. Wireless networks and mobile computing systems were used in 23 ICUs (46%).ConclusionOntario ICUs demontrate a high prevalence of the use of basic information technology systems. However, implementation of the more complex and potentially more beneficial applications is low. The wide variation in vendors utilized may impair information exchange, interoperability and uniform data collection.

Abstract 2710: Emergency Room Utilization of Continuous Intravenous Furosemide Together With the American Heart Association Get With the Guideline Heart Failure Care (GWTG-HF) Decreases Length of Stay for Hospitalized Heart Failure Patients at St. Joseph’s Regional Medical Center (SJRMC)

The main goals of therapy for hospitalized congestive heart failure (CHF) patients are to achieve euvolemia and to administer optimal standards of care. No study to date has examined ways to implement use of continuous intravenous furosemide (IVF) in the Emergency Room (ER) and ensure that each CHF patient consistently receives optimal standards of care throughout their hospitalization. Therefore, we hypothesized that a multi-disciplinary team approach with coordination of care from ER arrival to discharge (DC) with use of the AHA GWTG-HF Program will decrease length of stay (LOS) and provide optimal care for CHF patients as compared to usual care. METHODS: GWTG-HF was operational in 2006 with a multi-disciplinary team consisting of a Physician Champion, Advanced Practice Nurses (APNs), Case Managers and RNs. In June of 2006 the IVF program was implemented in coordination with the ER, Cardiology and Medicine Departments. ER physicians were prompted by an electronic medical record provider order entry (EMR-POE) CHF order set. GWTG-HF APNs followed these patients throughout their hospitalization. We compared the average LOS of CHF patients who received usual care in 2005 (Group I) to CHF patients who received IVF and GWTG-HF care from 6/06 to 4/07 (Group II). RESULTS: CHF cases in Group I equaled 773 as compared to 212 cases in Group II. Average LOS in I was 6.7 days as compared to 5.5 days in II (p = 0.001). Overall compliance with GWTG-HF Core Measures in 2006 was 98%. CONCLUSIONS: 1. Implementation of IVF in the ER with an EMR-POE order set helps ensure utilization of IVF in the ER at time of admission for CHF patients; 2. A multi-disciplinary team approach with use of IVF along with GWTG-HF is associated with a significant decrease in the LOS as compared to usual care; 3. A multi-disciplinary team approach to care for the CHF patient is superior to usual care with regards to LOS; and 4. GWTG-HF is associated with a high compliance with standards of hospitalized CHF care.

Chemotherapy administration associated errors before and after use of electronic order entry and decision support

19528 Chemotherapy Administration Associated Errors Before and After Use of Electronic Order Entry and Decision Support Background: Chemotherapy administration is an important part of oncology practice and as treatment plans have evolved, their complexity has increased. Our practice has developed a software program that incorporates decision support and safety checks. Here we report the errors we have noted before and after utilization of this system. Methods: Drug administration errors are tracked through a mandatory “incident report” process that requires staff to report whenever an error is recognized. All reports from 2003 (the year before utilization of the chemotherapy software) and 2006 were reviewed. We compared the number and type of errors from the two time periods. Results: • Statistically significant *increase or † decrease at alpha level 0.05. • 1rate is expressed per 100,000 treatments • 2 “Other” errors are those which could not be classified otherwise and had no impact on the patient Conclusions: The frequency of recognized errors associated with chemotherapy administration is very low (0.03%) and while still unacceptable, much lower than the 5% reported for medication administration in general. (Kaushal, Arch Int Med 163:1409 2003) A computerized software support system did not make a statistically significant change in the total frequency of administration errors but did significantly decrease wrong drug errors even as the complexity of treatment protocols increased. A class of error “Planned Drug Missed” was recognized because of a formal declaration of treatment plan. There may be significant reporting bias consequent to increased recognition and subsequent reporting of errors when a computerized system and formal declaration of treatment plan is in place. However, no matter the system, the human/computer interface remains a potential source of error. [Table: see text] No significant financial relationships to disclose.

Cost‐effectiveness of an electronic medication ordering and administration system in reducing adverse drug events

Adverse drug events (ADEs) are common and cause significant morbidity and mortality. Patient safety groups advocate the implementation of electronic medication order entry systems to reduce ADEs. However, these systems are costly, and there are limited data on their effectiveness. We conducted a study to examine the costs of introducing an electronic medication ordering and administration system and its potential impact on reducing ADEs. An incremental cost-effectiveness analysis was performed comparing an electronic medication ordering and administration system to the standard system used at a large health care institution over a 10-year time horizon. Estimates of effect were obtained from the literature. Cost data were obtained from a health care institution in Toronto, Canada. The incremental cost-effectiveness of the new system was $12,700 (USD) per ADE prevented. The cost-effectiveness was found to be sensitive to the ADE rate, to the effectiveness of the new system, the cost of the system, and costs due to possible increase in doctor workload. An electronic medication order entry and administration system could improve care by reducing adverse events. Unfortunately there are limited data on effectiveness of these systems at reducing ADEs. Further research is required to determine more precisely the potential economic benefit of this technology.

A novel method of continuous measurement of head of bed elevation in ventilated patients

We developed a novel pressure transducer-based method of continuous measurement of head of bed elevation. Following validation of the method we hypothesized that head of bed angles would be at or above 30 degrees among mechanically ventilated patients throughout the day due to a hospital-wide initiative on ventilator-associated pneumonia prevention and standardized electronic order entry system to keep head of bed at an angle of 30 degrees or greater. Prospective observational study in university hospital intensive care units. Twenty-nine consecutive mechanically ventilated patients with no contraindications for semirecumbency. We acquired 113 pairs of measurements on unused beds for validation of the method at angles between 3 degrees and 70 degrees. Correlation between transducer and protractor was fitted into a linear regression model (R2 = 0.98) with minimal variation of data along the line of equality. Bland-Altman analysis showed a mean difference of 1.6 degrees +/- 1.6 degrees. Ninety-six percent of differences were within 2 SD from the mean. This method was then used among 29 intubated patients to collect head of bed data over a 24-h period for 3 consecutive days. Contrary to our hypothesis, all patients had head of bed angles less than 30 degrees. Our results suggest that this method could be used with high reliability and patients in our institution were not kept even at 30 degrees. The results are in accord with those of a recent study which found that continued maintenance of previously suggested head of bed angles was difficult to attain clinically. This may lead us to reevaluate methods studying the impact of head of bed elevation in VAP prevention.

028–The Effects of Electronic Order Entry Program and Nursing Documentation on Nurse–Physician Communication and Ways to Improve It

028–The Effects of Electronic Order Entry Program and Nursing Documentation on Nurse–Physician Communication and Ways to Improve It

The Benefits of the MOE/MAR Implementation: A Quantitative Approach

Once the decision was made to implement an electronic medication order entry and medication administration record system at the University Health Network, a significant question soon emerged: How would UHN be able to determine if the project had indeed accomplished its stated objectives of improving patient safety and the medication ordering and processing cycle?

Information resources used in antimicrobial prescribing

To describe resources clinicians use when they prescribe antimicrobials, the authors surveyed prescribers by telephone within hours (median 2.9) after they ordered one or more antimicrobials for a patient. Among 157 prescribers, 87 (55%) used one or more external resources to aid in decisions about their order. The other 70 (45%) used only their own knowledge and experience. Fifty-nine (38%) consulted another person. Fifty-four (34%) used a print, computer, or Internet resource. In multivariate analysis, use of an external resource was associated with the clinician being on the medical service (odds ratio [OR] 2.99, 95% confidence interval [CI] 1.41–6.3) or being an intern (OR 13.65, 95% CI 1.44–128). Eighty percent of providers said information about antimicrobial prescribing at the point of electronic order entry would be helpful. It was concluded that decision support at the point of electronic order entry is likely to be used and might improve antimicrobial prescribing.

Charting the use of electronic health records and other information technologies among child health providers

BackgroundPrevious studies regarding the use of information technologies (IT) specifically among pediatricians and other physicians who treat children are lacking. As such, the objective of this study is to examine the use of electronic health record (EHR) systems and other IT applications among pediatricians and other child health providers (CHPs) in Florida.MethodsWe focus on pediatricians and other CHPs who responded to a state-wide physician survey of IT use. CHPs included general pediatricians, pediatric sub-specialists, and family physicians who self-reported a practice composition of at least 20% children. We compared general pediatricians to other CHPs and all CHPs (including pediatricians) to other physicians with respect to computer and internet availability, and to the use of personal digital assistants and EHRs. Those with an EHR were also compared regarding the availability of key functions available in their system. Statistical analyses included chi-square analysis and logistic regression models which controlled for numerous factors.ResultsA total of 4,203 surveys (28.2% response) including 1,021 CHPs, were returned. General pediatricians (13.7%) were significantly less likely to be using an EHR than both CHP family physicians (26.1%) and pediatric sub-specialists (29.6%; p < .001). In multivariate analysis, only general pediatricians were significantly less likely than other physicians to indicate the use of an EHR system (OR = .43; 95% C.I. = .29 – .64). Overall, CHPs were less likely to have key functions available in their EHR system including electronic prescribing (53.3% vs. 61.9%; p = .028), and electronic order entry (47.7% vs. 57.2%; p = .017) among others. General pediatricians and pediatric sub-specialists frequently lagged behind CHP family physicians with respect to key EHR functions. In contrast, CHPs had growth charts (51.3% vs. 24.0%; p < .001) and weight-based dosing functions (35.5% vs.22.7%; p < .001) more frequently than others.ConclusionPhysicians caring for children, and especially pediatricians, in Florida, are significantly slower than other doctors to adopt EHRs, and important electronic patient safety functionalities, into their office practices.

Proliferation of Electronic Health Records Among Obstetrician-Gynecologists

To examine the current use of electronic health records (EHRs) and their key subfunctions among obstetrician-gynecologists and compare this trend with other doctors. In this study, we examined responses to a large statewide study of EHR use among Florida physicians practicing in the ambulatory setting. For assessment purposes, we compared obstetrician-gynecologists with other primary care physicians (PCPs) and surgeons with respect to EHR utilization, the availability of key EHR functions, and time since adoption. In addition, we examined adoption intentions among non-EHR users. To compare differences among groups, the chi-square test was utilized with significance level set at P < .05. A total of 2428 responses (28.4% response rate), of which 454 were from obstetrician-gynecologists, were available for the current study. EHR use among obstetrician-gynecologists (18.3%) was significantly less (P < .001) than among PCPs (25.7%) and surgeons (20.5%). Among EHR users, obstetrician-gynecologists were significantly less likely than PCPs to have the following desirable EHR functions: problem lists (P < .001), medication lists (P < .001), allergy information (P = .014), electronic prescribing of medications (P = .001), electronic order entry (P = .009), electronically available laboratory results (P = .002), electronic connection to pharmacy information (P = .008), preventative service reminders (P < .001), and patient education material (P = .004). Moreover, obstetrician-gynecologists were significantly more likely to have adopted their system within the last 2 years. However, among nonusers, they were not more likely to indicate the intention to adopt EHR. Compared with peers, obstetrician-gynecologists are less likely to be using EHR in their practice. In addition, their systems tend to have fewer medical error preventing functions and fewer basic functions.