Primary care capacity as insurance coverage expands: examining the role of health information technology.

Objectives: Under the Affordable Care Act, many newly insured Americans have the challenge of establishing care with a primary care physician (PCP). We sought to examine whether health information technology (HIT) use in primary care practices was associated with anticipated capacity to accept new patients.

Study Design: Secondary analysis of a cross-sectional survey of Michigan PCPs from the specialties of pediatrics, internal medicine, and family medicine, conducted from October to December 2012. HIT use was considered independently for 8 types of HIT and in aggregate as a total count of HIT in use. Primary care capacity was assessed as self-reported capacity to accept new patients.

Results: Of 739 respondents, 83% reported they anticipated capacity to accept new patients. In multivariable analysis, we found that physiians using a greater number of HITs were significantly less likely to anticipate capacity to accept new patients (adjusted odds ratio [OR] = 0.86; 95% CI, 0.76-0.97). PCPs with higher HIT use were also less likely to accept patients with private insurance (adjusted OR 0.87; 95% CI, 0.77-0.97), but not with Medicaid (adjusted OR 0.94; 95% CI, 0.84-1.05) or Medicare (adjusted OR 0.91; 95% CI, 0.83-1.01). Among individual HITs, electronic health records (adjusted OR 0.54; 95% CI, 0.30-0.96) and electronic access to admitting hospital records (adjusted OR 0.46; 95% CI, 0.22-0.96) were the only HITs significantly associated with lower anticipated primary care capacity.

Conclusions: 
PCPs using a greater number of HITs were less likely to anticipate capacity to accept new patients. Implementation of HIT and other practice innovations must be carefully coordinated to optimize capacity to care for the newly insured.