Information Technologies: When Will They Make It Into Physicians' Black Bags?

Anne-Marie Audet, MD, MSc; Michelle M. Doty, PhD, MPH; Jordon Peugh, MA; Jamil Shamasdin; Kinga Zapert, PhD; Stephen Schoenbaum, MD, MPH

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In This Article

Abstract and Introduction

Context: Physicians in the United States are only slowly adopting information technology (IT) tools, despite studies demonstrating their clinical benefits. More is known about IT use within institutional settings than by individual physicians.
Objectives: This study investigates physicians' current use of, future plans for, and perceived barriers to adopting electronic medical records (EMRs), computerized prescribing and order entry, clinical decision support systems, and electronic communication (email) with other physicians and with patients.
Design: Self-administered mail surveys were completed between March and May 2003 among a national random sample of physicians involved in direct patient care of adults. A total of 1837 surveys were returned for a response rate of 52.8%.
Results: Physicians most commonly use IT for billing. For clinical management, the most common tool is computerized access to laboratory results (59%). Other tools are less prevalent: Twenty-seven percent of respondents use EMRs routinely or occasionally; 27% prescribe or order tests electronically; and 12% receive electronic alerts about potential drug-prescribing problems. Only 24% of surveyed physicians practice in a "high-tech" office setting. Physicians in groups of 50 or more are significantly more likely to use any IT tools and to practice in a high-tech office, as compared with physicians in solo practice (odds ratio = 7.7). The top 3 barriers to adoption of IT are start-up costs (56%), lack of uniform standards (44%), and lack of time (39%).
Conclusion: Most physicians do not use EMRs and related technologies. Adoption is uneven, and a technologic divide exists between physicians depending on their practice environment and mode of compensation. Cost remains the most important barrier to adoption. Attention needs to be focused on policies and business models that will make IT tools accessible and affordable to all physicians.

The diffusion of information technology (IT) in healthcare has been modest, at best.[1,2,3] Few healthcare organizations use electronic medical records (EMRs), although they have become a highly sophisticated and powerful tool since the first rudimentary ones were trialed nearly 30 years ago.[4,5,6,7] The situation is similar for related technologies, such as clinical decision support systems (CDSSs) and computerized prescribing and order entry. Perhaps 90% to 96% of physicians make personal use of the Internet, yet less than 20% of physicians in office-based practices may use EMRs.[3,8,9]

IT can, however, improve healthcare's efficiency and quality.[10,11,12,13,14] Computerized drug order entry reduces costly and dangerous medication prescribing errors.[12,15,16,17] The benefits of CDSSs in preventive care[14,18] and management of chronic diseases[10,19] have also been documented. However, there is little published information about their actual or possible adoption by US physicians, and about the factors that may affect physicians' resistance or ability to adopt such tools. Financial and cultural factors are likely to play a role in physicians' attitudes and behaviors. Adopting various technologies requires an investment of resources for the tools themselves and time to learn how to use and then maintain these systems, which for clinicians translates in time away from direct patient care. Practice settings and mode of compensation could affect the degree to which physicians are willing or able to invest and adopt IT in their practices.[20] Cultural issues may also affect their readiness to change.[21] For example, compared with physicians who choose the independence of solo practice, those who practice in larger groups or institutional settings could be more likely to respond favorably to peer recommendations and to adopt practices similar to others in the group, thus becoming part of an early majority or even late majority of adopters, as opposed to lagging behind.[22] The purpose of this study is to gain a better understanding of the extent to which physicians are using IT in their daily practices. We also explore the factors that are associated with physicians' use and attitudes toward IT.

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