NEJM survey: EHRs are helpful, but U.S. adoption rates remain sluggish

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Physicians who use EHRs believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, EHR systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters, according to a national survey published online in the June 18 issue of the New England Journal of Medicine.

Catherine M. DesRoches, DrPH, from the Massachusetts General Hospital in Boston, and colleagues assessed physicians’ adoption of outpatient EHRs; their satisfaction with such systems; the perceived effect of the systems on the quality of care; and the perceived barriers to adoption.

In late 2007 and early 2008, DesRoches and colleagues conducted a national survey of 2,758 physicians, which represented a response rate of 62 percent.

Using a definition for EHRs that was based on expert consensus, the researchers determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices.

The investigators said that 4 percent of physicians reported having an extensive, fully functional EHRs system, and 13 percent reported having a basic system.

Among the 83 percent of respondents who did not have EHRs, the researchers said that 16 percent reported that their practice had purchased but not yet implemented such a system at the time of the survey. An additional 26 percent of respondents said that their practice intended to purchase an EHR system within the next two years, the authors wrote.

In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use EHRs. Physicians reported positive effects of the systems on several dimensions of quality of care and high levels of satisfaction, according to the researchers.

The authors wrote that financial barriers were viewed as having the greatest effect on decisions about the adoption of EHRs.

While DesRoches and colleagues said they were encouraged that a large majority of respondents reported overall satisfaction with their EHR system, but noted that approximately 20 percent of physicians with basic systems expressed reservations about the ease of use and reliability of their systems.

The authors concluded that “improving the usability of EHRs may be critical to the continued successful diffusion of the technology.”