Factors associated with difficult electronic health record implementation in office practice

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Physicians running their own practice are required to demonstrate the meaningful use http://clinfowiki.org/wiki/index.php/Meaningful_Use of health information technology (HIT) as of 2015. The consequence of not doing so would cost financial loss for the physician’s practice mainly due to the reduction of Medicaid reimbursements. Another consequence of not using an electronic health record (EHR) would be that the physician’s office would not be able to deliver the standard of care now required under the healthcare reform. Physicians with their own practice are more likely to have difficulty with EHR implementation than physicians who are employed at a facility. Health IT Regional Extension Centers (HITREC) now exist throughout the country, through the federal government. The use of outside help to aid office physicians in the implementation of EHRs might result in a more successful implementation. Still, implementation of EHRs remains slow to adopt and some hindrances include fear of change, loss of confidentiality, cost, and disruption in workflow. A study was done using data from practices in three different communities participating in the Massachusetts eHealth collaborative (MAeHC) EHR implementation project. The purpose of this study was to identify the factors that cause difficulty in the process of EHR implementation. [1]


Data that was collected includes the attitudes, demographics and practice characteristics of physicians. A pre and post intervention survey was given to the practices in three different communities to measure the physician’s perception of the difficulties of EHR implementation. MAeHC installed EHR in physician’s practices between the year of 2006 and 2008. MAeHC also provided the offices with on-site consultation to aid in the workflow design and integration of the EHR. Technical support was also provided. A total of 167 physician practices participated in this study. The pre-intervention survey was given in 2005 and had the goal of measuring physicians’ attitudes towards perceptions of quality of care, demographics, practice characteristics and attitudes towards the use of computers in healthcare. The post-survey was given after the completion of the project in 2009.


All 163 physicians were able to complete both surveys in 2005 and 2009. Out of the 163, 54 physicians reported that the implementation process was very difficult. Eighty-four physicians reported the process to be somewhat difficult and 18 reported the no difficulty in the process.


Physicians who were employed by practices experienced an easier time with EHR implementation. The physicians who had ownership stake in their practices perceived EHR implementation to be more difficult compared to other physicians. It was also realized the important role that office staff play in the implementation of EHR. EHR implementation in the future should include the needs of the physicians who own the practice and should also focus on the critical role that office staff members play in the transformation process.

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  1. Factors associated with difficult electronic health record implementation in office practice Marshall Fleurant, Rachel Kell, Chelsea Jenter, Lynn A Volk, Fang Zhang, David W Bates, Steven R Simon Journal of the American Medical Informatics Association Jul 2012, 19 (4) 541-544, retrieved October 7, 2015, from http://jamia.oxfordjournals.org/content/19/4/541 DOI: 10.1136/amiajnl-2011-000689