Resistance to Electronic Medical Records (EMRs): A Barrier to Improved Quality of Care

Introduction Most industries have aggressively embraced the use of information technology (IT); however, healthcare is one noticeable exception. According to Morrissey (2005, p. 42), U.S. hospitals and multiple-facility health systems are "only beginning to round out their clinical networks, but are much farther along than physician practices. " While many inpatient or hospital facilities have migrated from paper charts to electronic records little progress has been made in the ambulatory or outpatient setting (Versel, 2002). According to Versel (2002) the vast majority (greater than 85%) of individual and group physician practices have been reluctant to embrace electronic medical records and continue to rely on paper charts. Paper medical records or charts are by nature data rich, but information poor as physicians and other health care providers have limited time to dig through volumes of paper to retrieve information, utilize it in decision-making and/or share it with patients. Ambulatory EMR systems hold tremendous promise for not only improving the quantity and quality of clinical data that can be recorded, but more importantly the ability to access health care data to improve quality of care. Unfortunately, although a myriad of EMR applications/ vendors are available, it has been estimated that it will take at least a decade for physician adoption to reach 80 percent (Versel, 2002). The purpose of this paper is threefold: 1) to examine why physicians have been reluctant to adopt EMRs; 2) to provide specific examples of how EMRs can improve quality of care; and 3) to report findings from a recent study focused on physician perceptions concerning EMRs. First, the paper examines the EMR literature to develop a basis for this investigation. The literature review necessarily examines findings related to EMRs, most notably that having to do with physician acceptance and EMR functionality. Second, the paper describes specific opportunities for improving quality of care via EMRs. Next, the paper presents findings from a 2003 study that offers insight into contemporary physician perceptions. Following a discussion of the findings both limitations of the study and opportunities for future research are presented. Background and Prior Research Electronic Medical Records For nearly two decades both vendors and well-respected medical and health-care journals and magazines have touted EMRs as a means to dramatically improve physician efficiency (productivity and cost) and effectiveness (quality of care). There is little doubt that interest in ambulatory EMRs has increased over the past decade, yet only a small fraction of providers have adopted such systems. This slow rate of adoption suggests resistance among physicians remains strong. In 2003, over one-half (53%) of the healthcare executives participating in an annual survey conducted by Modern Healthcare and PricewaterhouseCoopers cited physician acceptance as a barrier (Morrissey, 2005). According to Hier (2002), physician "buy-in" has been limited which has delayed widespread adoption of EMRs. Kadas (2002) observed that a combination of social, market and economic factors have prevented acceptance of computer-based patient records (CPRs). Khoury (1997) suggested that the perceived value of EMRs was inadequate to motivate physicians to use them. Physician resistance to EMRs has been attributed to a variety of factors including, but not limited to: 1) well-publicized EMR failures; 2) limited computer literacy on the part of physicians; 3) concerns over productivity (i.e., fear that an EMR would slow physicians down); 4) patient satisfaction, and 5) unreliable technology (e.g., Hier, 2002; Hodge, 2002; Kadas, 2002; Khoury, 1997). Kadas (2002) suggests that acceptance has also been adversely impacted by the absence of "reputable independent third party" research substantiating benefits. If physician acceptance or "buy-in" is in fact a critical success factor in widespread adoption of EMRs, it is appropriate and necessary that the perceptions of physicians concerning such applications be examined. …