Use of electronic patient records and encrypted email patient communication among Swiss chiropractors: a population-based cross-sectional study

Background: The implementation of electronic health information technologies is a key target for healthcare quality improvement. Among Swiss chiropractors, reliable data on the use of electronic heath information technologies and distribution of the health workforce was lacking. Objectives: To estimate the prevalence of electronic patient record (EPR) and encrypted email communication use among Swiss chiropractors and describe the geographic distribution of chiropractors in Switzerland. Methods: Population-based cross-sectional study of all active practising members of the Swiss Chiropractic Association (ChiroSuisse) between 3 December 2019 and 31 January 2020. We asked about clinician and practice characteristics, EPR use for clinical record keeping, use of encrypted email for patient communication, and information on EPR and encrypted email communication products used. Multivariable logistic regression analyses assessed the association between clinician and practice characteristics and (1) EPR use and (2) encrypted email use. Results: Among 286 eligible Swiss chiropractors (193 [68%] men; mean age, 51.4 [SD, 11.2] years), 217 (76%) completed the survey (140 [65%] men; mean age 50.7 [11.2] years). The density of chiropractors in Switzerland was 3.3 per 100,000 inhabitants. 47% of respondents (95% confidence interval [CI], 40% to 54%) reported using an EPR in their practice, while 60% (95% CI, 54% to 67%) endorsed using encrypted email technology. Chiropractors aged ≥60 (versus those ≤39) years were 74% less likely to use an EPR system (OR 0.26, 95% CI 0.08 to 0.77), while clinicians from practices with 4 or more chiropractors (versus those from solo practices) were over 5 times more likely to report EPR use (OR 5.6, 2.1 to 16.5). Findings for factors associated with encrypted email use were similar. Conclusions: As of January 2020, 286 duly licensed chiropractors were available to provide musculoskeletal healthcare in Switzerland — just under 50% of Swiss chiropractors used an EPR system in clinical practice, while 60% used encrypted email technology. Better implementation of EPR and electronic health information technologies in Swiss chiropractic practice is possible and desirable for the purpose of musculoskeletal healthcare quality improvement.