Electronic medical record adoption among physician organizations

Background. Use of electronic medical records (EMRs) in health care organizations can reduce medical errors and improve quality of care through physicians' increased use of evidence-based patient are processes. However, only 20%--25% of physician organizations have adopted EMRs. A study was undertaken to better understand drivers of and barriers to adoption in these organizations.;Objectives. One objective of the study was to determine the structural and market characteristics that distinguish EMR adopter from non-adopter organizations. A second objective was to identify the predictors of use of an important EMR feature, order entry with decision support for chronic disease care. Finally, an in-depth examination of one organization's adoption decision-making and vendor selection processes aimed to identify barriers and facilitators in these processes.;Methods. A quantitative nationwide survey was undertaken of all primary care physician organizations in the United States with 20 or more physicians; data were collected on 1,104 organizations, representing a 70% response rate. In addition, interviews were conducted with seven senior leaders within one organization to develop a case study of its decision-making processes.;Results. Fewer than one-third of the organizations reported having an EMR. Hospital or health maintenance organization (HMO) ownership was the strongest predictor of EMR adoption; larger, older organizations with relatively fewer practice locations were also more likely to adopt an EMR. External incentives were a significant predictor of both EMR adoption as well as of the use of order entry with decision support.;Drivers of the EMR adoption decision revealed in the case study included competitive pressure and a desire to improve quality of care and patient safety. Barriers included the time consuming nature of the process and the need to secure funding from the affiliated health system.;Discussion. Large physician organizations owned by hospitals or HMOs are more likely to have the financial and human resources necessary to overcome barriers to EMR adoption. Financial and non-financial incentives for all physician organizations will help drive both EMR adoption and use of its more sophisticated components. Financial and technical assistance aimed specifically at smaller groups is particularly warranted. Widespread adoption of EMR among physician organizations will take time.