If electronic medical records are so great, why aren’t family physicians using them?

TABLE 3
Attitudes and beliefs regarding electronic medical records

TABLE 4
Possible barriers to electronic medical record use

Discussion

Despite the low penetration of EMRs (14.4%), family physicians in Indiana are interested in using EMRs. Most users (85.4%) and nonusers (76.2%) expressed interest in a system that would securely connect all physician practices, laboratories, radiography facilities, and hospitals in their area for exchanging patient data. Many family physicians are currently using the Internet (67%), e-mail (53%), computers (93%), and PDAs (30%) in their practice.

Despite this expressed interest, only two thirds of nonusers believe that physicians should computerize their medical records. This may be related to the fact that only half of the responding nonusers perceive that current EMRs are useful for physicians. There was also a considerable lack of belief that EMRs will improve quality or reduce medical errors. Replies to the open-ended question indicated that 5% to 10% of respondents, for a variety of reasons, have strong feelings about computerizing their offices. A targeted, educational effort to show the advantages of EMRs may be useful for improving physician perceptions of EMRs.

The demographic profile of the nonusers may indicate that current EMRs are not perceived as being well adapted for use in rural, solo, or small-group practice. EMRs may be thought of as more feasible for larger organizations with larger capital budgets and robust information technology support systems. The differences in the volume of patients treated between users and nonusers suggest that productivity concerns may also be important.

Both EMR users and nonusers believe current EMRs are too costly. The data suggests that family physicians are willing to pay a relatively low set-up charge <$5000 would be accepted by more than 87% of respondents) and a very low monthly fee (<$100 would be accepted by more than 81% of respondents) for the use of an EMR. Few current EMRs can be installed and operated within these price specifications. This supports the previously published view that physicians believe current EMRs are not cost effective.¹⁷ Lower prices or greater perceived value is needed for physicians to consider EMRs a wise business choice.

Data entry is a concern for both users and nonusers. Practicing family medicine requires varied skills, a fast pace, treating patients from multiple age groups, diagnosing conditions from a myriad of potentially unrelated complaints, and keeping a comprehensive record from multiple sources. These factors make data entry the largest potential obstacle to the effective use of computers in family medi-cine.^1,14,18-20 Our data indicate that only 55% of users and 13.4% of nonusers believe data entry is easy for current EMRs. Perceived and actual ease of data entry must be improved before widespread adoption of EMRs by family physicians can be realized.

Concerns about security and confidentiality generated the largest number of written comments. Despite evidence to the contrary,^{9,23,24,28,29} nonusers believe that there are more security and confidentiality risks involved with EMRs than paper records. A small group emphatically expressed dismay at the possibility of subjecting their office to a “Big Brother”-type system. The Health Insurance Portability and Accountability Act (HIPAA) sets the standards for medical record (electronic and written) confidentiality and security, and the creation of an EMR that is HIPAA compliant may give providers greater confidence in its security and confidentiality.^23,24 Educating physicians about the security and confidentiality risks of paper records and the safeguards built into EMR programs may help alleviate these concerns.