Physicians in the United States are only slowly adopting information technology (IT) tools, despite studies demonstrating their clinical benefits. More is known about IT use within institutional settings than by individual physicians.
This study investigates physicians' current use of, future plans for, and perceived barriers to adopting electronic medical records (EMRs), computerized prescribing and order entry, clinical decision support systems, and electronic communication (email) with other physicians and with patients.
Self-administered mail surveys were completed between March and May 2003 among a national random sample of physicians involved in direct patient care of adults. A total of 1837 surveys were returned for a response rate of 52.8%.
Physicians most commonly use IT for billing. For clinical management, the most common tool is computerized access to laboratory results (59%). Other tools are less prevalent: Twenty-seven percent of respondents use EMRs routinely or occasionally; 27% prescribe or order tests electronically; and 12% receive electronic alerts about potential drug-prescribing problems. Only 24% of surveyed physicians practice in a "high-tech" office setting. Physicians in groups of 50 or more are significantly more likely to use any IT tools and to practice in a high-tech office, as compared with physicians in solo practice (odds ratio = 7.7). The top 3 barriers to adoption of IT are start-up costs (56%), lack of uniform standards (44%), and lack of time (39%).
Most physicians do not use EMRs and related technologies. Adoption is uneven, and a technologic divide exists between physicians depending on their practice environment and mode of compensation. Cost remains the most important barrier to adoption. Attention needs to be focused on policies and business models that will make IT tools accessible and affordable to all physicians.
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"An EMR system that provides alerts and automated suggestions can improve adherence to prevention protocols , thereby reducing medical errors . Family physician practices play an essential role in the delivery of healthcare services but are least likely to adopt complex innovations such as EMR systems, particularly small practices  . According to the Commonwealth Fund International Health Policy Survey of Primary Care Physicians, Canada ranked 10th out of 11 countries in terms of physicians' use of EMR systems in their practice in 2012 . "
[Show abstract][Hide abstract] ABSTRACT: Background:
EMR system can provide three main types of benefits: it can solve the logistical organization problems associated with paper systems; it can improve the quality of professionals' clinical decisions; and it can improve physicians' return on their practices by reducing the cost of managing clinical information. According to the 2012 Commonwealth Fund International Health Policy Survey, Canada ranked 10th out of 11 countries in terms of family physicians' adoption of EMR systems. Our main purpose is to investigate the reasons why so many primary care medical practices in this country have not decided to invest in these systems yet.
To achieve our main objective, a mixed-methods study was performed. We first conducted a Delphi study with a panel of 21 experts made up of general practitioners with extensive professional experience and a very good understanding of the issues surrounding the introduction of health IT in private medical practices. As a second step, we collected and analyzed data from a large questionnaire survey of family physicians working in medical practices without EMR systems (n = 431).
The Delphi study reveals that private medical practices are hindered by four types of barriers when faced with the initial decision to invest in an EMR system, namely, behavioral, cognitive or knowledge-based, economic, and technological. Survey findings then indicate that the key challenges preventing private medical practices from investing in an EMR system are mainly related to economic and knowledge barriers. Surprisingly, we also found a cluster of medical practices which, although they have not invested in an EMR system, perceive no such barriers to adoption.
A thorough understanding of the barriers faced by family physician practices in adopting an EMR system would help governments and other key stakeholders target policies and measures in support of medical practices. The "one size fits all" approach to such policies and measures is clearly inappropriate, given this study's findings that many medical practices face practically no barriers to EMR adoption, and that others differ markedly as to the type of barriers faced, be they mostly "soft" such as knowledge barriers or "hard" such as economic barriers.
International Journal of Medical Informatics 06/2014; DOI:10.1016/j.ijmedinf.2014.06.003 · 2.00 Impact Factor
"Additionally, whereas earlier clinical information systems, such as those for laboratory results, pharmacy, and picture archiving and communication , focus on specific tasks or departments within a hospital, EHRS have the potential to integrate various systems and serve as a platform technology. To the degree that EHRS exhibit considerable value potential, and in light of the fact that EHRS assimilation is low in the U.S. healthcare sector (Angst et al. 2010, Audet et al. 2004, Miller et al. 2005), it is important to understand the dynamics underlying this phenomenon. "
[Show abstract][Hide abstract] ABSTRACT: With the lack of timely and relevant patient information at the point of care increasingly being linked to adverse medical outcomes, effective management and exchange of patient data has emerged as a strategic imperative for the healthcare industry. Healthcare informaticians have suggested that electronic health record systems (EHRS) can facilitate information sharing within and between healthcare stakeholders such as physician practices, hospitals, insurance companies, and laboratories. We examine the assimilation of EHRS in physician practices through a novel and understudied theoretical lens of physicians' identities. Physician practices and the physicians that lead them occupy a central position in the healthcare value chain and possess a number of unique characteristics that differentiate them from other institutional contexts, including a strong sense of affiliation with other physicians, potent professional identities, and a desire for autonomy. We investigate two salient physician identities, those of careprovider and physician community, grounded in the roles physicians play and the groups with which they affiliate. We argue that these identities and their evolution, triggered by EHRS, manifest as both identity reinforcement and deterioration, and are important drivers of EHRS assimilation. We use survey data from 206 physician practices, spread across the United States, to test our theoretical model. Results suggest that physician community identity reinforcement and physician community identity deterioration directly influence the assimilation of EHRS. We further find that the effects of careprovider identity reinforcement and careprovider identity deterioration on EHRS assimilation are moderated by governmental influence. Theoretical and pragmatic implications of the findings are discussed.
Information Systems Research 09/2012; 23(3):738-760. DOI:10.2307/23276483 · 2.15 Impact Factor
"Past studies have suggested that providers who use EMRs tend to focus on the benefits of the systems more than the barriers, as compared to providers who have not implemented EMRs (Gans et al. 2005; Scheck McAlearney et al. 2004). Other studies have found that practice setting and size are factors in physician acceptance of EMRs (Audet et al. 2004). It is an open question whether patterns such as these will be found among behavioral health providers. "
[Show abstract][Hide abstract] ABSTRACT: Interviews with 32 community behavioral health providers elicited perceived benefits and barriers of using electronic health records. Themes identified were (a) quality of care, (b) privacy and security, and (c) delivery of services. Benefits to quality of care were mentioned by 100% of the providers, and barriers by 59% of providers. Barriers involving privacy and security concerns were mentioned by 100% of providers, and benefits by 22%. Barriers to delivery of services were mentioned by 97% of providers, and benefits by 66%. Most providers (81%) expressed overall positive support for electronic behavioral health records.
Community Mental Health Journal 05/2011; 48(2):249-54. DOI:10.1007/s10597-011-9409-6 · 1.03 Impact Factor