Subscribe to RSS
DOI: 10.4338/ACI-2011-01-RA-0003
Adoption of Electronic Health Records
A Qualitative Study of Academic and Private Physicians and Health Administrators This project was funded by a grant from the National Library of Medicine, grant number 5 G08 LM008271-02, titled “Advancing Academic and Community Practices through IAIMS.”Publication History
Received:
12 January 2011
Accepted:
04 April 2011
Publication Date:
16 December 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201102/lookinside/thumbnails/10-4338-aci-2011-01-ra-0003-1.jpg)
Summary
Objective: Less than 20% of hospitals in the US have an electronic health record (EHR). In this qualitative study, we examine the perspectives of both academic and private physicians and administrators as stakeholders, and their alignment, to explore their perspectives on the use of technology in the clinical environment.
Methods: Focus groups were conducted with 74 participants who were asked a series of open-ended questions. Grounded theory was used to analyze the transcribed data and build convergent themes. The relevance and importance of themes was constructed by examining frequency, convergence, and intensity. A model was proposed that represents the interactions between themes. Results: Six major themes emerged, which include the impact of EHR systems on workflow, patient care, communication, research/outcomes/billing, education/learning, and institutional culture. Academic and private physicians were confident of the future benefits of EHR systems, yet cautious about the current implementations of EHR, and its impact on interactions with other members of the healthcare team and with patients, and the amount of time necessary to use EHR’s. Private physicians differed on education and were uneasy about the steep learning curve necessary for use of new systems. In contrast to physicians, university and hospital administrators are optimistic, and value the availability of data for use in reporting.
Conclusion: The results of our study indicate that both private and academic physicians concur on the need for features that maintain and enhance the relationship with the patient and the healthcare team. Resistance to adoption is related to insufficient functionality and its potential negative impact on patient care. Integration of data collection into clinical workflows must consider the unexpected costs of data acquisition.
-
References
- 1 Kohn Lea. To err is human. National Academy Press 1999
- 2 Institute of Medicine Committee on Quality of Health Care in America.. Crossing the quality chasm: A new health system for the 21st Century. 1st ed.: National Academies Press; 2001
- 3 Safety, Committee on Data Standards for Patient.. Patient safety: achieving a new standard for care. 1st ed.: National Academies Press; 2004
- 4 HIMSS Definitions [Internet].. Chicago: Healthcare Information and Management Systems; [cited 2011 Mar 23]. Available from http://www.himss.org/ASP/topics_ehr.asp.
- 5 Bates DW, Ebell M, Gotlieb E, Zapp J, Mullins HC. A proposal for electronic medical records in U. S. primary care. J Am Med Inform Assoc 2003; 10 (Suppl. 01) 1-10.
- 6 Jha AK, Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. Int J Med Inform 2008; 77 (Suppl. 12) 848-854.
- 7 Executive Order 13410: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs [Internet].. Washington: Federal Register; [updated 2006 Aug 26; cited 2011 Mar 23]. Available from http://edocket.access.gpo.gov/2006/pdf/06–7220.pdf.
- 8 State of the Union [Internet].. Washington: The White House; [updated 2010 Jan 27; cited 2011 Mar 23]. Available from: http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.
- 9 Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009 Apr 9 360 (Suppl. 15) 1477-1479.
- 10 Ford EW, Menachemi N, Peterson LT, Huerta TR. Resistance is futile: but it is slowing the pace of EHR adoption nonetheless. J Am Med Inform Assoc 2009; 16 (Suppl. 03) 274-281.
- 11 Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Med Inform Decis Mak 2009; 9-15.
- 12 Rogers EM. Diffusion of innovations. New York: Free Press; 1995
- 13 Moore GA. Crossing the chasm : marketing and selling disruptive products to mainstream customers. Rev. ed. New York, NY: HarperBusiness Essentials; 2002
- 14 Lorenzi NM, Novak LL, Weiss JB, Gadd CS, Unertl KM. Crossing the implementation chasm: a proposal for bold action. J Am Med Inform Assoc 2008; 15 (Suppl. 03) 290-296.
- 15 Lorenzi NM. Strategies for creating successful local health information infrastructure Initiatives. 2003
- 16 Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc 2000; 7 (Suppl. 02) 116-124.
- 17 Lorenzi NM, Riley RT. Organizational issues = change. Int J Med Inform 2003; 69: 197-203.
- 18 Hersh.. Health care information technology: progress and barriers. JAMA –Journal of the American Medical Association 2004; 292: 2273.
- 19 Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U. S. hospitals. Health Aff (Millwood) 2004; 23 (Suppl. 04) 184-190.
- 20 Coye MJ, Kell J. How hospitals confront new technology. Health Aff (Millwood) 2006; 25: 163-173.
- 21 Hillestad R, Bigelow J, Bower A, Girosi F, Meili R, Scoville R. et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood) 2005; 24 (Suppl. 05) 1103-1117.
- 22 Glaser BG, Strauss AL. editors. The discovery of grounded theory : strategies for qualitative research. Chicago: Aldine Pub. Co.; 1967
- 23 Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 3rd ed.: Sage Publications, Inc; 2007
- 24 Krueger PRA, Casey DMA. Focus Groups: A Practical Guide for Applied Research. 3rd ed.: Sage Publications, Inc; 2000
- 25 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004; 11: 104-112.
- 26 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2014; 415-423.
- 27 Ash JS, Bates DW. Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion. J Am Med Inform Assoc 2005; 12: 8-12.
- 28 Ash JS, Sittig DF, Campbell E, Guappone K, Dykstra RH. An unintended consequence of CPOE implementation: Shifts in power, control, and autonomy. AMIA Annu Symp Proc 2006: 11-15.
- 29 Ash JS, Sittig DF, Dykstra RH, Guappone K, Carpenter JD, Seshadri V. Categorizing the unintended socio-technical consequences of computerized provider order entry. Int J Med Inform 2007; 76 (Suppl. 01) 21-27.
- 30 Campbell EM, Sittig DF, Ash JS, Guappone KP, Dykstra RH. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006; 13: 547-556.
- 31 Sittig DF, Krall M, Kaalaas-Sittig J, Ash JS. Emotional aspects of computer-based provider order entry: a qualitative study. J Am Med Inform Assoc 2005; 12: 561-567.
- 32 Joos D, Chen Q, Jirjis J, Johnson KB. An electronic medical record in primary care: impact on satisfaction, work efficiency and clinic processes. AMIA Annu Symp Proc 2006: 394-398.
- 33 O’Connell RT, Cho C, Shah N, Brown K, Shiffman RN. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc 2004; 11: 43-49.
- 34 Middleton B, Hammond WE, Brennan PF, Cooper GF. Accelerating U. S. EHR adoption: how to get there from here. recommendations based on the 2004 ACMI retreat. J Am Med Inform Assoc 2005; 12: 13-19.
- 35 Middleton B. Achieving US health information technology adoption: The need for a third hand. Health Affairs 2005; 24: 1269.
- 36 van der Meijden MJ, Tange H, Troost J, Hasman A. Development and implementation of an EPR: how to encourage the user. Int J Med Inform 2001; 64: 173-185.
- 37 Ford EW, Menachemi N, Phillips MT. Predicting the adoption of electronic health records by physicians: when will health care be paperless?. J Am Med Inform Assoc 2006; 13: 106-112.
- 38 Report to the president realizing the full potential of health information technology to improve healthcare for americans : The path forward [internet]. Washington: President’s Council of Advisors on Science and Technology; [updated 2010 Dec 8; cited 2011 Mar 23]. Available from: http://www.whitehouse.gov/sites/de fault/files/microsites/ostp/pcast-health-it-report.pdf