Overcoming Barriers to Implementing Electronic Health Records in Rural Primary Care Clinics

Abstract

Medicare-eligible physicians at primary care practices (PCP) that did not implement an electronic health record (EHR) system by the end of 2015 face stiff penalties. One year prior to the 2015 deadline, approximately half of all primary clinics have not implemented a basic EHR system. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants’ experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs systems as manadated by federal legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants including (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of change management at rural medical practices. This study may provide rural primary care physicians and administrators with strategies to promote the adoption of EHRs, provide cost efficient business services, and improve change management plans.

Attitudes and Perceptions of General Practitioners towards the National Electronic Health Record (NEHR) in Singapore

“…Doctors who perceived that there is inadequate support, both financially and technically, were also less likely to review or review and upload onto NEHR, results similar to many of the other studies done. 10,13,[20][21][22]24,30 This is in spite of a significant level of funding being channelled into NEHR implementation by the MOH Singapore.…”

“…[33][34][35] With regard to barriers involving organisation, these include the lack of administrator involvement in the physician's implementation of EHR 22,23 and an organisation's control and supervision undermining a physician's autonomy. 24,33,34 Barriers regarding inadequacy of training include lack of and/or insufficient training 13,17,33,34 and lack of sufficient assessments and feedback to ensure that users are proficient 13 and competent trainers. 14 Adequacy of support can be categorised as either technical or financial support.…”

“…Specific technical support barriers include a lack of interoperability in supporting and migrating data from previous systems, 9,17-20 unreliable technological support, 14,20 and a lack of infrastructure for technical assistance. 10,13,22 The financial barriers involve mainly the cost of implementation [22][23][24] and EHR maintenance. 20,21,24,30 Personal factors affecting the use of EHR include barriers pertaining to age, 25,26 practice site, 13,22 computer literacy and technical sophistication, 9,11,21,27,28,35 and perceived negative effects on the patient-doctor relationship.…”

“…10,13,22 The financial barriers involve mainly the cost of implementation [22][23][24] and EHR maintenance. 20,21,24,30 Personal factors affecting the use of EHR include barriers pertaining to age, 25,26 practice site, 13,22 computer literacy and technical sophistication, 9,11,21,27,28,35 and perceived negative effects on the patient-doctor relationship. 18,19,33,34 Ethico-legal issues include breaches of security [30][31][32] and compromised patient confidentiality.…”

Integrative of Perceived Management Support on Information Technology Innovativeness

“…Consequently, management plays an essential role in the detection of information technology innovations given a suitable environment, and in making polices that enhance the successful creation and execution of understanding (Mason, 2015).…”