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

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Original Research

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

J Fam Pract. 2002 July;51(7):636-641

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References

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It is encouraging that both users and nonusers seem to understand the potential usefulness of EMRs. Over half of the nonusers believe an EMR is a useful way to provide patient education materials, participate in clinical and health services research, launch a literature search (eg, Medline), or obtain up-to-date treatment guidelines. To increase the number of physicians using EMRs, vendors should maximize and promote the use of EMR features.

The results of this study are limited by the response rate. Although this rate introduces the possibility of a nonresponse bias, it is comparable to or exceeds the response rate in other physician EMR surveys.^11,12,23-27 Evidence of nonresponse bias includes the high rate of EMR use by Indiana family physicians (14.4%) compared to previous studies, suggesting users were more likely to respond than nonusers. Questionnaires that were returned early in the survey showed an EMR use rate of 40%, but this number dropped quickly after the first 2 weeks. A very small percentage of questionnaires returned near the end of the study were from EMR users. The nonresponse bias of the study is likely toward EMR users and nonusers who have seriously considered using EMRs; since this is the segment of the physician market most likely to adopt EMRs, the sample is likely adequate for the attempted analysis. The study is also limited by its focus on family physicians in Indiana, and may differ from the views of physicians in other specialties or states.

Conclusions

Our data demonstrate the existence of a chasm between EMR users (early adopters) and nonusers (mainstream market) regarding attitudes and perceptions that impact the implementation of EMRs by family physicians. Specifically, EMR nonusers exhibit the following important differences from users: (1) less perceived need for EMRs; (2) greater concerns about EMR data entry; (3) less confidence in the security and confidentiality of EMRs; and (4) more concerns about the cost for installation and ongoing use of EMRs.

Further studies are needed to examine nonusers in more detail and to discover if current EMRs can meet the needs of the mainstream physician user. Our research suggests that data entry, cost, security and confidentiality, and connectivity issues are important starting points. A qualitative study of nonusers is desirable to better understand the true needs of the mainstream physician. Broadening this study to include all specialties throughout the country would also be useful.

The IOM has repeatedly called for the computerization of the US medical system.^7,28,29 Government, industry, and physician organizations should use the results of this study to target their research, education, and marketing efforts regarding EMRs, and to develop EMRs that meet the needs of most practicing family physicians, especially family physicians in small group, high-volume, rural or suburban practices.

Acknowledgments

This study was undertaken as part of the faculty development fellowship at the University of North Carolina Department of Family Medicine and funded by the Bureau of Health Professions grant no. HRSA#1-D14-HP00019. We thank the Indiana Academy of Family Physicians, St. Francis Family Practice Residency, Indiana University Department of Family Medicine, Bowen Research Center, UNC Faculty Development Fellowship 2000–2001 fellows, Nancy Loomis, and Jenny Kirby for their support.