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Abstract

NONE DECLARED. Electronic Medical Records (EMRs) are computerized medical information systems that collect, store and display patient information. They are means to create legible and organized recordings and to access clinical information about individual patients. Despite of the positive effects of the EMRs usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. The EHRs represent an essential tool for improving both in the safety and quality of health care, though physicians must actively use these systems to accrue the benefits. This study was unsystematic-review. The aim of this study was to express barriers perceived y physicians to the adoption of the EHRs. This study was non-systematic reviewed which the literature was searched on barriers perceived by physicians to the adoption of Electronic Health Records (EHRs) with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. FOR OUR SEARCHES, WE EMPLOYED THE FOLLOWING KEYWORDS AND THEIR COMBINATIONS: physicians, electronic medical record, electronic health record, barrier, and adoption in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 27 of them were selected based on their relevancy. Electronic health record use requires the presence of certain user and system attributes, support from others, and numerous organizational and environment facilitators.
Barriers for Adopting Electronic Health Records (EHRs) by Physicians
aCTa inFOrM MeD. 2013 Jun; 21(2): 129-134 / prOFeSSiOnal paper
129
Barriers for Adopting Electronic Health Records
(EHRs) by Physicians
Sima Ajami, Tayyebe Bagheri-Tadi
Department of Health Information Technology, Health Management & Economics Research Center, School of
Medical Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Corresponding author: Tayyebe Bagheri-Tadi. School of Medical Management and Information Sciences, Isfahan University of Medical
Sciences, Isfahan, Iran. E-mail: bagheri774@yahoo.com.
1. INTRODUCTION
e Institute of Medicine reported
to Err is Human that building a Safer
Health System cites one of the most
extensive adverse drug event studies,
the Harvard Medical Practice Study,
and notes that 58 percent of adverse
events due to errors in the study were
preventable, 27.6 percent were due to
negligence, and 19 percent were due
to drug complications which were the
most common adverse event. In order
to: 1) reduce medical errors, 2) pro-
vide more effective methods of com-
municating and sharing informa-
tion among clinicians, and 3) better
manage patient medical records, we
need to embrace information tech-
nology in healthcare. Since medical
errors are a leading cause of death in
the United States and since paper re-
cords can be easily lost, misplaced, or
are oen illegible, the use of electronic
health record technology would elim-
inate many of these issues and lead
to major improvements in the health
and safety of patient care (1).
Electronic Medical Records
(EMRs) are computerized medical in-
formation systems that collect, store
and display patient information.
ey are means to create legible and
organized recordings and to access
clinical information about individual
patients. e EMRs and Electronic
Health Records (EHRs) are viewed
as interchangeable synonyms in most
health informatics. Other similar ex-
pressions exist albeit with a some-
times slightly restricted focus (2).
e Institute of Medicine and
others have suggested that the wide-
scale adoption of the EHRs could be
pivotal for improving patient safety
and health care quality. EHRs may
also reduce the costs of providing
ambulatory care. However, despite
emerging evidence about the benefits
of EHRs, there are considerable bar-
riers to adoption (3).
e health care sector is an area
of social and economic interest in
several countries; therefore, there
have been lots of efforts in the use
of electronic health records. Never-
theless, there is evidence suggesting
that these systems have not been ad-
opted. Physicians have a central role
in the use of the EHRs, as they are
who provide much of the informa-
tion that the systems handle in their
automated processes (4).
Despite broad agreement on the
benefits of electronic health records
and other forms of health informa-
tion technology, health care pro-
viders have moved so slowly to adopt
these technologies. Lack of readiness
causes weakness of organization to
undergo transformation during the
implementation of the EHRs (5). Ac-
cording to Meinert, the slow rate of
adoption suggests that resistance
among physicians must be strong be-
cause physicians are the main front-
line user-group of EMRs. Whether or
not they support and use EMRs will
have a great influence on other user-
groups in a medical practice, such as
nurses and administrative staff. As a
result, physicians have a great impact
Professional paper
ABSTRACT
Introduction: Electronic Medical Records
(EMRs) are computerized medical informa-
tion systems that collect, store and display
patient information. They are means to create
legible and organized recordings and to access
clinical information about individual patients.
Despite of the positive effects of the EMRs
usage in medical practices, the adoption rate
of such systems is still low and meets resis-
tance from physicians. The EHRs represent an
essential tool for improving both in the safety
and quality of health care, though physicians
must actively use these systems to accrue the
benets. This study was unsystematic-review.
Aim: The aim of this study was to express bar-
riers perceived y physicians to the adoption of
the EHRs. Method of the study: This study was
non-systematic reviewed which the literature
was searched on barriers perceived by physi-
cians to the adoption of Electronic Health
Records (EHRs) with the help of library, books,
conference proceedings, data bank, and also
searches engines available at Google, Google
scholar. Discussion: For our searches, we
employed the following keywords and their
combinations: physicians, electronic medi-
cal record, electronic health record, barrier,
and adoption in the searching areas of title,
keywords, abstract, and full text. In this study,
more than 100 articles and reports were col-
lected and 27 of them were selected based
on their relevancy. Electronic health record
use requires the presence of certain user and
system attributes, support from others, and
numerous organizational and environment
facilitators.
Key words: physicians; electronic health re-
cord; barrier; adoption
ACTA INFORM MED. 2013 Jun; 21(2): 129-134
doi: 10.5455/aim.2013.21.129-134
Received: 15 January 2013 • Accepted: 26 March 2013
conflict of interest: none declared
© AVICENA 2013
Barriers for Adopting Electronic Health Records (EHRs) by Physicians
prOFeSSiOnal paper / aCTa inFOrM MeD. 2013 Jun; 21(2): 129-134
130
on the overall adoption level of EMRs
(6).
Mille and Sim stated that based on
a qualitative study of physician prac-
tices that had implemented an EMR,
quality improvement depends heavily
on physicians’ use of the EMR and
not paper for most of their daily tasks
(7). e adoption and meaningful use
of electronic health records (EHRs) is
a major US national policy priority
for improving the quality and effi-
ciency of the healthcare system. is
topic has received bipartisan support
and led to the US Congress allocating
close to $30 billion in 2009 to pro-
mote adoption of interoperable, cer-
tified the EHRs (8).
According to Randeree, as tech-
nology continues its impact in
healthcare, the adoption of new IT
options has been able to reduce costs
and increase efficiencies. Health care
professionals now turn to various pa-
tient-centric technologies, including
computerized patient records (CPR),
document management systems,
data warehouses, point-of-care appli-
cations, distributed networks, and
telematics (Telematics typically is
any integrated use of telecommunica-
tions and informatics, also known as
ICT (Information and Communica-
tions Technology), to provide the in-
formation they need when they need
it (9).
Simon et al. argued that physi-
cians who had adopted an EHR con-
sistently reported more positive views
of the potential effect of computers
on health care than physicians who
did not yet (3).
Miscommunication, misinforma-
tion and misinterpretation between
vendors, clinic executives, IS leaders,
and end-users (physicians and sta)
has contributed to a myriad of prob-
lems in the marketing, selection, im-
plementation and utilization of the
EMRs (5).
e aim of this study was, to iden-
tify and discuss about barriers for
adopting Electronic Health Records
(EHRs) by physicians.
2. METHODS
is study was un-systematic re-
view which the literature on physi-
cians’ resistance in adoption of Elec-
tronic Health Records on a formal re-
Title Author Expected or experienced barriers
What factors affect the use of
electronic patient records
by Irish GPs?
Meade B et al. (10)
Lack of time;
Lack of nancial resources;
Absence of computer skills;
Results of a survey of an online
physician community regarding use of
the EMRs in ofce practices.
Ross (11)
High cost;
Loss of autonomy;
Workow disruption.
Correlates of EHRs Adoption in Ofce
Practices: A Statewide Survey
Simon et al. (3)
Start-up nancial costs;
Ongoing nancial costs;
Loss of productivity.
Doctors’ use of the EMRs systems in
hospitals: cross sectional survey
Lærum et al. (12)
Access to computers and computer literacy;
Flexibility of paper records;
Traditional work routines.
A knowledge-based taxonomy of
critical factors for adopting EHR
systems by
physicians: a systematic literature
review
Castillo et al. (4)
User attitude towards;
information systems
Workow impact;
Interoperability;
Technical support;
Communication among users;
Expert support.
If the EMRs are so great,
Why family physicians don’t use them?
Loomis et al. (13)
Data entry;
Less condence in the
security and condentiality;
Concern about the cost for installation and ongoing
usage of EMRs.
Primary Care Physicians’ Experience
with
EMRs: Barriers to Implementation in
a Fee-for-Service Environment
Ludwick et al. (14)
Training and after-sales experience with the vendor;
Technical support from the vendor;
Extra time needed for data entry;
Time constraint in procurement and
Implementation;
Computer skills of the physicians;
Disruption of the ow of information.
Use of EMRs in Oman and Physician
Satisfaction
Farsi (15)
Malfunction;
Concern about privacy;
Cost.
An organizational learning perspective
on the assimilation of the EMRs among
small physician practices
Reardon et al. (16)
Investment cost;
Productivity loss;
Lack of nancial incentives.
Adoption of EHRs in Primary Care
Pediatric Practices
Kemper et al. (17)
System downtime;
Increase in physician workload;
Providers have inadequate computer skills;
Increase in staff workload;
Staff have inadequate computer skills;
Patient condentiality;
Expense of implementation;
Lack of clear return on investment;
No improvement in patient care or clinical outcomes;
Interference with doctor-patient relationship;
Inability to nd an EHRs that meets the pediatric
practice’s requirements;
Inability to interface with existing practice systems;
Transience of vendors 70.1;
Bad previous experience with EHRs.
EHRs in small physician practices:
Availability, use, and perceived
benets.
Rao et al. (7)
Capital needed to acquire and implement;
Uncertainty about return on investment;
Resistance to adoption from practice physicians;
Capacity to select, contract and install the EHR;
Concern about loss of productivity during transition;
Concern about inappropriate disclosure of patient
information;
Concern about illegal record tampering/hacking;
Concern about the legality of accepting the EHR from
a hospital;
Concern about physician’s legal liability
Finding an EHR that meets your needs;
Concern that the system will become obsolete;
EHRs: Use, barriers and satisfaction
among physicians who care for black
and Hispanic patients
Jha et al. (18)
Computer skills of you and/or colleagues/
staff;
Computer technical support;
Lack of time to acquire knowledge about
system;
Start-up nancial costs;
Ongoing nancial costs
Training and productivity loss;
Physician skepticism;
Privacy or security concerns;
Barriers for Adopting Electronic Health Records (EHRs) by Physicians
aCTa inFOrM MeD. 2013 Jun; 21(2): 129-134 / prOFeSSiOnal paper
131
search framework. We used a sub-sys-
tematic method, which was divided
into three phases: literature collec-
tion, assessing, and selection. e lit-
erature search was conducted e lit-
erature was searched on barriers per-
ceived by physicians to the adoption
of the EHRs with the help of library,
books, conference proceedings, data
bank, and also searches engines avail-
able at Google, Google scholar. For
our searches, we employed the fol-
lowing keywords and their combina-
tions: Physicians, electronic medical
record, electronic health record, bar-
rier, adoption in the searching areas
of title, abstract and full text.
More than 100 articles were col-
lected. Aer exclude duplicated arti-
cles, some articles were excluded base
on the following criteria: 1) article
related to barriers linked to physi-
cians no to other medical staff, 2) ar-
ticle focused on EHR, not involving
other electronic systems. Aer fil-
tering 27 articles were selected. We
investigated all of them to identified
barriers to the acceptance of EHRs
by physicians. en we studied how
these barriers affect on physicians’ re-
sistance using EHR. Finally we pro-
posed some useful interventions that
can act as references for implementers
of Electronic Health Records.
3. RESULTS
All of the barriers that have men-
tioned in the 20 articles have showed
in the following Table 1.
Information is enough valuable
and it must be well documented,
maintained, retrieved and analyzed.
In health management systems, in-
formation has a special role in plan-
ning, evaluation, training, legal as-
pects and research (24). In fact, the
first distinction between developed
and developing countries, are the
production, application and utiliza-
tion of information (25, 26, 27).
Some articles had similar barriers.
Most barriers were mentioned in ar-
ticles are discussed below:
3.1. Time
Physicians do not take the time to
properly become familiar with the
available products, select an EMR,
implement it, and then train to use it
even though colleagues have invested
time and realized great benefit (13).
Taking extra time to use EHR and
not being compensated for taking a
lighter load were perceived barriers.
Physicians reported that they needed
but did not always have time to use
the system fully, to participate in fur-
ther training, or to learn new features
(22).
3.2. Cost
Physicians have to weigh the costs
of creating and supporting their own
IT structure and applications, or
using external vendors to provide the
services. ese costs may include pur-
chase price, coordination costs, mon-
itoring costs, and negotiating costs,
upgrade costs, and governance costs.
ese costs act contrary to the ben-
efits provided by the EMR. For small
to medium sized practices without
large IT budgets, costs remain the
biggest barrier to adoption (8). e
high up-front financial costs of im-
plementing EMRs are a primary bar-
Exploring Physician Adoption of EMRs:
A Multi-Case Analysis
Randeree (8)
1) Cost;
2) Increase in staff workload;
2) Supplier presence;
3) Vendor trust;
4) Customizability;
5) Reliability.
Physicians and EHRs
A Statewide Survey
Simon et al. (19)
Costs;
Quality of health care;
Interactions with the health care team;
Patient-physician communication;
Patient privacy
Adopting EMRs primary care:
Lessons learned from health
information systems
implementation experience in seven
countries
Ludwick et al. (20)
Privacy;
Patient safety;
Provider/patient relations;
Staff anxiety;
Time factors ;
Quality of care;
Finances;
Efciency;
Liability.
Physicians In Non-primary Care And
Small Practices And Those Age 55 And
Older Lag In Adopting EHR Systems
Decker et al. (21)
Practice size;
Physician age;
Ownership status;
Physicians’ Use Of EMRs: Barriers And
Solutions
Miller et al. (6)
High initial nancial costs;
Slow and uncertain nancial payoffs;
High initial physician time costs;
Difculties with technology;
Complementary changes and support;
Electronic data exchange;
Financial incentives.
Resistance Is Futile: But It Is Slowing
the Pace of EHR Adoption Nonetheless Ford et al. (22)
Uncertainty about implementation costs, causes and
effects;
Uncertainty about shifting standards;
Uncertainty about potential policy interventions.
Resistance to EMRs:
A Barrier to Improved Quality of Care
Meinert (5)
Learning curve;
Impact on productivity;
Response time;
Cost;
Security;
Patient acceptance;
Privacy;
Complexity;
Training needs.
What Stands in the Way of
Technology-Mediated Patient Safety
Improvements? A Study of Facilitators
and Barriers to Physicians’ Use of
EHRs
Holden (23)
Learning;
Typing prociency;
Understanding the EHR system;
Motivation/initiative;
Strategies/workarounds;
Supporting hardware/software system ;
Speed;
Functionality;
Usability;
Formal technical support;
Formal training;
Informal support from colleagues;
Time allowance;
Inter-institutional integration;
Physical space;
Electricity;
Wireless connectivity;
Social environment.
Table 1. Some experienced barriers to Adopt EHRs by physicians
Barriers for Adopting Electronic Health Records (EHRs) by Physicians
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132
rier to their adoption. is barrier is
compounded by uncertainty over the
size of any financial benefits that may
accrue over time (6).
3.3. Absence of computer skill
e skills needed to listen to pa-
tients’ complaints, assess medical rel-
evance, contemplate interventions as
well as type notes all at the same time
would require a significant level of
concentration, typing skills, and fa-
miliarity with the applications user
interface, not normally found in the
most adept computer users (13).
EMR providers appear to under-
estimate the level of computer skills
required from physicians, while the
system is not only seen as but in prac-
tice actually is very complex to use
by these physicians. Further, good
typing skills are needed to enter pa-
tient medical information, notes and
prescriptions into the EMRs, and
some physicians lack them (2).
3.4. Workflow disruption
Physicians do not take the time to
properly become familiar with the
available products, select an EMR,
implement it, and then train to use it
even though colleagues have invested
time and realized great benefit. e
skills needed to listen to patients’
complaints, assess medical relevance,
contemplate interventions as well as
type notes all at the same time would
require a significant level of concen-
tration, typing skills, and familiarity
with the applications user interface,
not normally found in the most
adept computer users (4).
3.5. Concern about security and
privacy
Despite of evidence to the con-
trary, nonusers believe that there are
more security and confidentiality
risks involved with EMRs than paper
records (12). ere is added concern
for privacy, confidentiality, and secu-
rity for computerized patient infor-
mation (14).
3.6. Communication among users
Communication among users
refers to the act of interchanging
thoughts, opinions, or information
by speech, or writing. Communica-
tion among users is as a very impor-
tant factor contributing to the user
acceptance of these systems. e
communication among users might
be encouraged through social net-
works to help innovation users pro-
mote social interaction, which assists
them to adopt innovations (4).
3.7. Interfaces with doctor-pa-
tient relationship
A few researchers have considered
the possibility of interaction prob-
lems between doctors and patients
when using EMRs. Patient eye contact
is and, therefore, the more complete
the interpersonal communication,
possibly leading to higher quality of
care. In the research by Ludwick et al.
some physicians reported that they
sometimes stop using EMRs because
hunting for menus and buttons dis-
rupts the clinical encounter (13).
3.8. Lack of incentives
e EMRs use could be increased
through financial rewards for quality
improvement and for public re-
porting of multiple measures of
quality performance (6).
3.9. Complexity
e multidisciplinary of screens,
options, and navigational aid Prob-
lems with EMR usability especially
for documenting progress notes
caused physicians to spend extra
work time to learn effective ways to
use the EMR. ese substantial ini-
tial time costs are an important bar-
rier to obtaining benefits, as greater
burdens on physicians’ time decrease
their use of EMRs, which lowers the
potential for achieving quality im-
provement (6).
3.10. Physical space
Barriers included cluttered work-
spaces, insufficient space for a paper
chart when using EHR, not enough
private rooms for computer use, com-
puter stations ill-suited to tall users,
and physicians not being physically
located at a computer station (e.g.,
when commuting (22).
3.11. Concern about the ability
to select an effectively install HER
system
Physicians were far more worried
about finding a system that met their
needs or the future obsolescence of
their EHR systems (7).
3.12. Technical support
Technical support facilitated use
both in the initial days and weeks of
EHR and aerward. Support staff was
generally perceived as knowledgeable
and helpful, although some physi-
cians noted that support staff was un-
available sometimes (off hours; holi-
days) (22).
3.13 Interoperability
Interoperability as a determinant
factor for adopting these systems that
interoperability could reduce rework
by care providers; improve dissemina-
tion and movement of new medical
knowledge among physicians. In-
teroperability is important because it
decreases the cost of electronic health
records and makes it feasible for an
individual or small group of physi-
cians to acquire and adopt these sys-
tems (4).
3.14. Access to computers and
computer literacy
e low level of electronic med-
ical records system use could be ex-
plained by a lack of available com-
puters. is would, however, affect
the use for all clinical tasks in a uni-
form manner (11).
3.15. Vendor trust
Lack of technical training and sup-
port from vendors has been reported
as a barrier to the adoption of EMRs
by physicians. erefore, the quality
of vendors of EMR systems is crucial
for the acceptance of EMRs. EMR
systems are still relatively new in the
marketplace. e lack of suitable ven-
dors reflects an immature industry,
without sufficient viable products
or competitors able to offer better
services, and without enough infor-
mation on vendors to enable an in-
formed decision. Physicians are con-
cerned that vendors are not qualified
to provide a proper service, or will go
out of business and disappear from
the market, leading to a lack of tech-
nical support and a large financial
loss (2).
3.16. Expert support
Expert support refers to the assis-
tance provided from a physician to
another physician. is can be di-
vided in two aspects: 1) a physician
with experience in electronic health
records usage assists, with informa-
tion about how to use the system, to
another physician; 2) a physician has
the knowledge to help another physi-
cian accomplish a medical task. Such
assistance can be given through per-
sonal contact or via documents (4).
3.17. Concern about data entry
Practicing family medicine re-
quires varied skills, a fast pace,
Barriers for Adopting Electronic Health Records (EHRs) by Physicians
aCTa inFOrM MeD. 2013 Jun; 21(2): 129-134 / prOFeSSiOnal paper
133
treating patients from multiple age
groups, diagnosing conditions from a
myriad of potentially unrelated com-
plaints, and keeping a comprehensive
record from multiple sources. ese
factors make data entry the largest
potential obstacle to the effective use
of computers in family medicine (4).
3.18. Training and aer-sail ex-
periences with their vendor
Our physicians complained about
their training and post-sale experi-
ence with their vendor. Instead of a
training regimen similar to that de-
scribed in the literature, physicians
reported that their vendor simply of-
fered one training session of one half
to a full day in duration. Training
was oen too soon aer implemen-
tation. Physicians had not developed
sufficient experience with their new
EMR to ask relevant questions or ap-
preciate the answers. Physicians re-
ported that they could not always ac-
cess vendor technical support (13).
3.19. Reliability
Reliability refers to the depend-
ability of the technology systems that
comprise the
EMR. As more vendors enter the
lucrative healthcare market, the
number of competing systems will
increase. Vendors will seek to differ-
entiate themselves from competitors
using quality and reliability of their
EMR systems as evidence of their su-
periority (8).
3.20. Inadequate data exchange
Another barrier to EMR use was
the lack of adequate electronic data
exchange between the EMR and
other clinical data systems (such as
lab, radiology, and referral systems).
Having parallel electronic and paper-
based systems forced physicians to
switch between systems, thereby
slowing workflow, requiring more
time to manually enter data from ex-
ternal systems, and increasing physi-
cians’ resistance to EMR use. To take
advantage of these developments
and to stimulate additional improve-
ments in clinical data exchange, pol-
icies should hasten the creation of
community wide data exchange sys-
tems that allow clinicians to view all
of their patients’ data, regardless of
provider and care site (6).
3.21. Concern about patient ac-
ceptance
Physicians would spend more time
interacting with the computer than
the patient. In these cases it was clear
that the respondents did not view the
EMR as an opportunity to enhance
or improve physician-patient commu-
nication (5).
3.22. Formal training
Although initial formal training
was depicted favorably by some, in-
sufficient training was oen identi-
fied as a barrier, either because there
was not enough training or because
classroom training was ill-suited
to physicians’ clinical needs and
learning styles (22).
3.23. Speed
System slowness in some units, but
not in others, was perceived as a bar-
rier to use (22).
3.24. Interinstitutional integra-
tion
Physicians could not use patient
data from EHRs to which they had
no access, having to instead rely on
printed documents. Physicians iden-
tified having to log in separately to in-
patient and outpatient EHR systems
as a barrier to “seamless access” (22).
3.25. Wireless connectivity
A broadband connection and
wireless connectivity facilitated use,
but these were not always available
(e.g., at nursing home; in some out-
patient clinics that a specialist might
visit) (22).
4. CONCLUSIONS
e review of identified articles
shows the wide range of possible
barriers to implementing EHRs. De-
spite the positive effects from using
EMRs in medical practices, the adop-
tion rate of such systems is still low
and they meet resistance from phy-
sicians. Electronic health record use
requires the presence of certain user
and system attributes, support from
others, and numerous organizational
and environment facilitators. In ad-
dition, difficulty of using EHRs and
the non-use of specific functions re-
sult from the presence of barrier.
For the EHR systems to have a posi-
tive impact on patient safety, clini-
cians must be able to use these sys-
tems effectively aer they are made
available. By considering the factors
identified in this study, it should be
possible to improve the ability of cli-
nicians to easily and effectively use
the EHR. at, in turn, will increase
the probability of quality and safety
improvements through the EHR. e
review showed that implementers
can insulate the project from such
concerns by establishing strong lead-
ership, using project management
techniques, establishing standards
and training their staff to ensure such
risks do not compromise implemen-
tation success. Many medical schools
do not employ the EHRs or train stu-
dents in their use. Training medical
students to rely upon EHRs and their
decision support tools can only serve
to accelerate universal the EHR adop-
tion. e findings of this study can be
used as an overview of barriers that
physicians might possibly see in the
EMR implementation process.
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... One of the best communication tools and targeted patient data collection is data registration systems [1]. [22,27,29] Lack of input data quality [5] Checking the effectiveness and calculating the financial indicators [4,5,21,26,30] Lack of special budget allocation for the development of rehabilitation interventions, programs and facilities [8,31] Development and use of clear security protocol [8,31] Concerned about sharing information [31] Develop objectives before creating the system [8,21,31] Lack of a clear goal [22] Sufficient investment is required to develop facilities and infrastructure [32][33][34] Lack of access to hardware infrastructure [32] Determining the standard framework and detailing the exact data elements [5] Absence of binding laws and regulations related to registration systems [32,33] Conduct further studies [33] Lack of access to sufficient information to implement information registration systems [22] Continuous evaluation and monitoring [32,33] Lack of continuous monitoring [33,34] Holding training courses to increase computer knowledge for employees [32,34] Lack of training courses ...
... One of the best communication tools and targeted patient data collection is data registration systems [1]. [22,27,29] Lack of input data quality [5] Checking the effectiveness and calculating the financial indicators [4,5,21,26,30] Lack of special budget allocation for the development of rehabilitation interventions, programs and facilities [8,31] Development and use of clear security protocol [8,31] Concerned about sharing information [31] Develop objectives before creating the system [8,21,31] Lack of a clear goal [22] Sufficient investment is required to develop facilities and infrastructure [32][33][34] Lack of access to hardware infrastructure [32] Determining the standard framework and detailing the exact data elements [5] Absence of binding laws and regulations related to registration systems [32,33] Conduct further studies [33] Lack of access to sufficient information to implement information registration systems [22] Continuous evaluation and monitoring [32,33] Lack of continuous monitoring [33,34] Holding training courses to increase computer knowledge for employees [32,34] Lack of training courses ...
... One of the best communication tools and targeted patient data collection is data registration systems [1]. [22,27,29] Lack of input data quality [5] Checking the effectiveness and calculating the financial indicators [4,5,21,26,30] Lack of special budget allocation for the development of rehabilitation interventions, programs and facilities [8,31] Development and use of clear security protocol [8,31] Concerned about sharing information [31] Develop objectives before creating the system [8,21,31] Lack of a clear goal [22] Sufficient investment is required to develop facilities and infrastructure [32][33][34] Lack of access to hardware infrastructure [32] Determining the standard framework and detailing the exact data elements [5] Absence of binding laws and regulations related to registration systems [32,33] Conduct further studies [33] Lack of access to sufficient information to implement information registration systems [22] Continuous evaluation and monitoring [32,33] Lack of continuous monitoring [33,34] Holding training courses to increase computer knowledge for employees [32,34] Lack of training courses ...
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Introduction: In recent decades, following the upward trend of aging, one out of three people in the world need rehabilitation services during the period of illness or injury. Considering the long-term complications and high costs of treatment, the need to follow up and review the evidence to find the best care programs and extensive planning in this field seems mandatory. Registry systems in this area can provide the necessary evidence for strategic decisions in this field. Therefore, the purpose of this comprehensive literature review is to examine the challenges and benefits of developing a rehabilitation registration system. Material and Methods: A systematic review, in studies published in English, without time limit and by searching for keywords in the keywords, title and abstract of reliable scientific databases Web of Science, Scopus, PubMed and Science Direct, as well as searching the title of studies in the database Cochrane data was accessed on March 31, 2021. Studies that were a possible answer to the researched question based on the title and content were examined. Results: One of the most important challenges investigated was the limitation of rehabilitation comprehensive registration systems. Other challenges include the lack of support for ensuring the quality of registration data, insufficient funds for investment, privacy and data security, the unclear purpose of registration system development, access to hardware infrastructure, lack of binding laws and regulations related to registration systems, lack of access to sufficient information. To implement information registration systems, continuous monitoring and holding training courses. Conclusion: The most important challenge investigated was that currently the health care and rehabilitation registration systems around the world are focused on single diseases (single discipline rehabilitation), which does not meet the needs of patients due to the multifactorial nature of rehabilitation services and chronic diseases. Therefore, it seems that the connection between the data registration systems with the help of a comprehensive guideline or model or the creation of a national integrated central database in the form of integration with other health information systems and based on electronic health records will be very efficient.
... In addition, AI-enabled systems must ensure data protection and allow the GP to work autonomously. In addition, politics and health insurance companies should consider monetary subventions for AI-based systems because a remarkable result of the review by Ajami and Bagheri-Tadi [89] is the positive influence of financial support on physicians' willingness to use and engage with technologies [89]. ...
... In addition, AI-enabled systems must ensure data protection and allow the GP to work autonomously. In addition, politics and health insurance companies should consider monetary subventions for AI-based systems because a remarkable result of the review by Ajami and Bagheri-Tadi [89] is the positive influence of financial support on physicians' willingness to use and engage with technologies [89]. ...
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Background: General practitioners (GPs) take care of a large number of patients with various diseases in very short timeframes under high uncertainty. Thus, systems enabled by artificial intelligence (AI) are promising and time-saving solutions that may increase the quality of care. Objective: This study seeks to understand GPs’ attitudes towards AI-enabled systems in medical diagnosis. Methods: We interviewed 18 GPs from Germany between March and May 2020 to identify determinants of GPs’ attitudes towards AI-based systems in diagnosis. By analyzing the interview transcripts, we identified 307 open codes, which we then further structured to derive relevant attitude determinants. Results: We merged the open codes into 21 concepts and finally into five categories: (1) concerns, (2) expectations, (3) environmental influences, (4) individual characteristics, and (5) minimum requirements of AI-enabled systems. Concerns include all doubts and fears of the interviewees regarding AI-enabled systems. Expectations reflect GPs’ thoughts and beliefs about expected benefits and limitations of AI-enabled systems in terms of GP care. Environmental influences include influences resulting from an evolving working environment, key stakeholders’ perspectives and opinions, the available IT hardware and software resources, and the media environment. Individual characteristics are determinants that describe a physician as a person, including character traits, demographic specifics, and knowledge. Besides, the interviews also revealed minimum requirements of AI-enabled systems, which are preconditions that must be met for GPs to contemplate using AI-enabled systems. Moreover, we identified relationships between these categories, which we conflate in our proposed model. Conclusions: This study provides a thorough understanding of the perspective of future users of AI-enabled systems in primary care and lays the foundation for successful market penetration. We contribute to the research stream of analyzing and designing socio-technical systems and the literature on attitude towards technology and practice by fostering the understanding of GPs and their attitude on AI-enabled systems. Our findings provide relevant information to technology developers and policymakers, and stakeholder institutions of GP care.
... This, in turn, means that nurses are still under a level of workload to deal with this new technological service (Shneiderman, 2011). In fact, the need for training and practical knowledge about the using of EHRs was mentioned by several researchers (Ajami & Bagheri-Tadi, 2013;Silow-Carroll, Edwards, & Rodin, 2012). This need is demonstrated by this study's finding. ...
Preprint
This research aims to explore the role of job satisfaction and motivation on administrative staff within the context of King Fahd Central Hospital in Jazan, Saudi Arabia. The literature review of this research highlighted a number of relevant theories of McGregor's theory and Maslow's hierarchy of needs, and Herzberg's two-factor theory to understand factors that affect motivation and satisfaction amongst employees. In order to fulfil such aim, this study adopted qualitative research and collected data through conducted online interviews with 12 administrative staff from the aforementioned hospital. The determined participants included four administrators, four secretaries and Four more receptionists. The results refer to interpersonal relationships with various management team members, financial rewards and compensations are factors that support work motivation. The findings indicate that positive working environment, the value of honest and transparent communication, job security, and open communication are factors that stimulate motivation amongst workers. A main limitation of this study is that the results cannot be generalised to the whole population reliably due to sample size.
... This, in turn, means that nurses are still under a level of workload to deal with this new technological service (Shneiderman, 2011). In fact, the need for training and practical knowledge about the using of EHRs was mentioned by several researchers (Ajami & Bagheri-Tadi, 2013;Silow-Carroll, Edwards, & Rodin, 2012). This need is demonstrated by this study's finding. ...
Preprint
This study aims to explored how applying EHRs affected the level of perceived workloads amongst nurses at King Fahad Hospital in Jazan, Saudi Arabia. Methodology was done by conducting quantitative research in which an online survey questionnaire was used to collect the data of nurses at the hospital. The questionnaire contained 16 items that measured the level of workload before the application of EHRs in 2015 and after the adoption of EHRs in 2016. A total of 235 responses, representing a 39.16 % response rate for the whole population of 600 nurses at King Fahad Hospital in Jazan, were collected. The data were analysed statistically via SPSS, and both descriptive and inferential analyses were done. The findings of this study indicate that, following the application of EHRs, the workload has decreased amongst nurses. Consequently, the levels of physical demand, mental demand, temporal demand, effort and frustration have decreased while the level of performance increased after the adoption of EHRs in 2016. The limited time available for collecting the data restricted the ability of the researcher to increase the response rate. Moreover, the Hawthorne effect is considered to be a limitation for this study.
... Physicians may lack the time or training needed, have insufficient up-to-date knowledge of recommendations, or resist the change [34,35]. Their conventional dependence on SABAs prescription and oversensitivity of corticosteroid side effects possibly restrain them from prescribing ICS [36]. ...
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Background: Several challenges face asthma management in Egypt, including the high percentage of uncontrolled patients, inadequate compliance, and overuse of short-acting beta-agonists (SABAs) leading to increased asthma-related morbidity and mortality. In this regard, the recent Global Initiative for Asthma (GINA) recommendations included inhaled corticosteroids containing therapy for mild asthma. Local healthcare systems and healthcare professionals (HCPs) often experience practical challenges when implementing global guidelines. Objective: The present expert review aims to outline the development of local guidelines and health policies that integrate global advances in asthma management while addressing unmet needs and challenges in Egypt. Methods: A steering committee of health policymakers and respiratory experts from the principal healthcare sectors in Egypt came together in March 2021 to develop a consent and national guideline for local asthma management, codifying the current challenges and the required elements for adequate control. The recommendations were either evidence-based or consensus-based from the clinical expertise and perspectives of the committee. Results: The committee identified vital challenges facing all chronic airway diseases with initial focus on asthma management in Egypt in diagnosis, data collection, policymaking, patients' awareness, and physicians' attitudes. In general, the committee stated that globally adapted management protocols necessitate addressing from diverse perspectives through policymakers, HCPs, and patients. Accordingly, it is vital to provide relevant education for the patient and HCPs. The recommendations emphasize key elements concerning baseline assessment, diagnosis, treatment strategy with regular review of patient progress, and compliance toward the introduced reforms. Conclusions: Full integration of these recommendations into local practice allows physicians to sustain adequate management while reducing preventable exacerbations and unnecessary burdens. The proposed strategies outline efficient patient-centered management that approaches asthma as an inflammatory condition, encouraging health promotion and patients' compliance.
... Last but not least, providers have concerns that EHR generates new issues on patients' privacy and confidentiality. All these reasons hamper their desire to use EHR [25]. 5. Design issues of EHR. ...
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