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

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 medicine. (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.

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.