If electronic medical records are so great, why aren’t family physicians using them?

The questionnaire consisted of 3 parts. The first section included questions about physician demographics, use of computer aided technology, practice location and type, and volume of patients. The second section contained questions about respondents’ attitudes, beliefs, and concerns regarding current and emerging technologic issues related to EMRs using a 4-point Likert scale ranging from “strongly agree” to “strongly disagree.” The Likert Scale also contained a “Don’t Know” option. The third section included multiple-choice questions to evaluate specific computer technology needs and preferences of family physicians. The final item was an open-ended question inviting a written response about any issues the respondent felt were not adequately addressed by the questionnaire.

Questionnaires were mailed in January 2001, with a followup mailing to nonrespondents 3 weeks later.²² Of the 726 (51.7%) responses, 45 (6.2%) were excluded because they did not indicate user or nonuser EMR status and 63 (8.8%) were excluded because half or more of the questions were unanswered. There were 618 (44.2%) usable surveys. The questionnaires were scanned into an electronic database and verified for accuracy using TELEform® software; the data were analyzed using SPSS^® (Version 10.0). The Likert scales were collapsed to a dichotomous variable, “agree” (strongly agree and agree) and “disagree” (strongly disagree, disagree, and unsure) for this analysis. Differences in demographic characteristics and attitudes, beliefs, and concerns were tested for significance using chi-square tests and the z-test of proportions. Statistical significance was determined by P < .05.

Results

Demographic and practice characteristics of the respondents are presented in Table 1. Of the 618 respondents, 89 (14.4%) were EMR users. A comparison of the users and nonusers revealed that there were no statistically significant differences in age or sex. EMR nonusers were more likely to practice in a suburban or rural location and were more often in a solo or small practice (2–6 physicians). Nonusers also tended to see an average of 31 more patients per week (116 vs 85).

Table 2 presents responses to questions about respondents’ experience with computer technology. A significantly greater proportion of EMR users use the Internet at home (98.9% vs 89.3%), at work (88.6% vs 62.8%), e-mail at work (78.4% vs 48.2%), and personal digital assistants (PDAs) (49.4% vs 26.1%). Other differences in technology use were not statistically significant.

Responses to questions about perceived EMR need and usefulness are summarized in Table 3. Nonusers were significantly less likely than users to believe that (1) physicians should computerize their medical records (67.7% vs 92.1%); (2) current EMRs are useful (51.5% vs 92.0%); (3) EMRs will reduce their risk of making medical errors (56.6% vs 78.7%); and (4) EMRs will improve health care quality in their office (52.4% vs 80.9%) or in the United States overall (54.3% vs 78.4%). Most respondents (77.6%) expressed an interest in an EMR system that would connect all physician practices, laboratories, radiography facilities, and hospitals for the secure exchange of patient data (85.4% user vs 76.2% nonuser; P = .076).

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 are 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 fee 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).

TABLE 1
Demographic characteristics of respondents

TABLE 2
Technology use by respondents