If electronic medical records are so great, why aren't family physicians using them? - Original Research

Journal of Family Practice, July, 2002 by Glenn A. Loomis, J. Scott Ries, Robert M. Saywell, Jr, Nitesh R. Thakker

Table 4 summarizes the attitudes and beliefs of respondents about previously reported potential obstacles to EMR use, including: (1) data input; (2) cost; and (3) confidentiality and security. (1,11,12,14,17-20,23,24) Few respondents (55.1% users vs 13.4% nonusers) stated that it is easy to enter data into current EMRs. Many respondents in both groups (61.8% vs 68.0%) responded that EMRs arc too costly. Users tend to consider a relatively higher price as affordable for setting up an EMR system (66% would pay more than $5000) and are willing to pay a slightly higher monthly tee for the ongoing use of an EMR (65% would pay more than $100 per month). Users consider EMRs as more secure (54.5% users vs 21.2% nonusers) and more confidential (62.5% users vs 21.9% nonusers) than paper records. Few respondents stated they would object to sharing their EMR data with other physicians (24.9% nonusers vs 13.6% users).

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.