Barriers to Electronic Health Record Adoption: a Systematic Literature Review

Abstract

Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.

Structured Data Entry in the Electronic Medical Record: Perspectives of Pediatric Specialty Physicians and Surgeons

“…The differences may reflect differences in computer skills required to enter medical information while also interacting in the work environment [13]. The findings reinforced the barriers associated with EHR implementation in general such as the need for tech support, technical concerns, and insufficient time, and workflow challenges [14,15].…”

“…This report of perceptions of specialty physicians and surgeons in during an EHR optimization phase contains feedback from one pediatric institution, which is a limitation. The small physician and surgeon groups do not have the required power to do a rigorous analysis of potential covariates noted in other studies such as cost and resistance to changing work habits [14]. Moreover, the participant specialty physicians and pediatric surgeons were a subgroup of the many clinicians who use the EHR and structured reporting in the institution.…”

Horizontal and vertical integration's role in meaningful use attestation over time

“…Several factors are likely to have contributed to the high level of attrition among independent physicians. First, purchasing and maintenance costs, as well as initial loss of productivity, are commonly cited barriers slowing physician adoption of an EHR . Independent physicians are likely to face higher per‐physician administrative and financial burden than large organizations, which can achieve efficiencies of scale by providing shared administrative and IT support to many providers.…”

Towards a deeper understanding of meaningful use in electronic health records

“…Whilst these papers offer interesting and useful perspectives, these attempts do not specifically help us in making sense of the diversity of Meaningful Use discourses in the U.S. health sector (Klecun, ). Indeed, the study of literature in the area by Kruse, Kristof, Jones, Mitchell, and Martinez () concluded that ‘Additionally, further research in the area of EHRs would likely profit from identifying key factors of achieving the current stages of Meaningful Use in an effective manner. This in particular would be most beneficial, as we believe that many health care institutions, as shown by the research, fail to achieve Meaningful Use as they have adopted an excessively basic EHR in order to meet the minimum standards for regulation under HITECH.…”