Electronic Health Records in Ambulatory Care - A National Survey of Physicians, New England Journal of Medicine, July 23, 2008
Here are some results from a national survey of 2758 physicians representing why they had or had not installed an EMR system. As of Summer 2008, fully functioning EMRs were reported in only 4% of practices surveyed, however 13% had installed "basic" systems. The survey measured why EMRs were adopted, the level of satisfaction, the effect on quality, and the barriers to adoption. It was conducted in late 2007 and early 2008 with response rate of 62%. Physicians who had adopted EMRs reported improved quality of care, streamlined practice communication and workflow, and prescription efficiencies among other benefits (listed below).
Major Barriers
1. Amount of capital needed, 66%
2. Finding an EMR to fit needs, 54%
3. Uncertainty about return on investment, 50%
4. Concern system will become obsolete, 44%
5. Concern about loss of productivity during transition, 41%
6. Capacity to select, contract, install and implement, 39%
7. Resistance from physicians, 29%
8. Concern about illegal record tampering, 18%
9. Concern about inappropriate disclosure of patient information, 17%
10. Concern about physicians' legal liability, 14%
11. Concern about legality of accepting EMRs from hospital, 11%
Positives
1. Timely access to records, >90%
2. Prescription refills, >80%
3. Quality of communication with other providers, >80%
4. Quality of clinical decisions, >60%
5. Avoiding medication errors, >80%
6. Quality of communication with patients, >60%
7. Delivery of quality care that meets guidelines, >50%.
8. Delivery of preventive care that meets guidelines, >50%.
It is difficult to reconcile these two lists. The survey shows very positive reviews by an overwhelming majority of EMR users. Yet, adoption rates for EHR remain low. The discrepancy appears to likely be related to a study design unable to factor in the degree of failed implementations. SOAPware is attempting to address the faulty industry approaches to implementation along with many of the other factors that have lead to low adoption rates, even in spite of the documented, positive benefits by many.
