Barriers to proliferation of electronic medical records.

BACKGROUND Error reduction, quality improvement and lowering of cost can all be achieved through electronic integration of healthcare providers. Proliferation of standard electronic health records/ electronic medical records (EHR/EMR) software is an essential precursor of this integration. Proliferation of EHR/EMR software has not occurred in the United States. OBJECTIVE To characterise users and non-users of EHR/EMR software, identify potential barriers to proliferation, examine the extent of standardisation across reported EHR/EMR and suggest possible solutions to identified barriers. METHODS We performed a secondary analysis of member survey data collected by the American Academy of Family Physicians (AAFP) in January 2003. The purpose of the survey was to measure interest in an AAFP-sponsored EHR/EMR service. We examined demographic and purchasing data from the survey by gender, population density, region and age. We also counted the number of different software vendors reported by users of an EHR/EMR to assess the number of users with unique software. RESULTS Of the 35,554 members contacted, 5517 (15.5%) responded. Of those responding, 1297 (23.5%) reported use of an EHR/EMR. Of the members responding, 81% reported interest in EHR/EMR software and 61% reported cost as a major reason for not purchasing it. At least 264 different EHR/ EMR software programs are currently in use. On average, the percentage of respondents with the same EHR/EMR software is 0.4%. DISCUSSION The number of AAFP members with unique EHR/EMR software is very large. Fragmentation, caused by the use of hundreds of unique systems, is a major barrier to proliferation of these systems. Many of the barriers to proliferation could be mitigated through the tools and techniques available through Free and Open Source Software (FOSS).

[1]  Piemonte Rv.  NSNA in the decade of the 90's. , 1992 .

[2]  H. Murff,et al.  Physician satisfaction with two order entry systems. , 2001, Journal of the American Medical Informatics Association : JAMIA.

[3]  B. Cuffel,et al.  Managed care: Toward open-source practices in managed behavioral health. , 2001, Psychiatric services.

[4]  Douglas Goldstein.  Open source powers the medical Internet today and tomorrow. , 2002, Managed care interface.

[5]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[6]  C. K. Barsukiewicz,et al.  Electronic medical records: are physicians ready? , 1999, Journal of healthcare management / American College of Healthcare Executives.

[7]  Gleiner Ja.  Paving the way for electronic medical records. , 2000 .

[8]  J. A. Gleiner.  Paving the way for electronic medical records. , 2000, Physician executive.

[9]  T. Bollinger.  Use of Free and Open-Source Software (FOSS) in the U.S. Department of Defense , 2003 .

[10]  Abha Agrawal,et al.  Return on investment analysis for a computer-based patient record in the outpatient clinic setting. , 2002, Journal of the Association for Academic Minority Physicians : the official publication of the Association for Academic Minority Physicians.

[11]  T. Brennan,et al.  Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. , 1998, The Joint Commission journal on quality improvement.

[12]  Thomas R. Yackel.  How the Open-Source Development Model Can Improve Medical Software , 2001, MedInfo.

[13]  Chessare Jb,et al.  Implementation of COSTAR in an academic group practice of general pediatrics. , 1993 .

[14]  E. Layman.  Health informatics: ethical issues. , 2003, The health care manager.

[15]  J. Wyatt,et al.  Evaluating computerised health information systems: hard lessons still to be learnt , 2003, BMJ : British Medical Journal.

[16]  P. Salus.  The Cathedral and the Bazaar , 2000 .

[17]  C. Safran,et al.  Real and imagined barriers to an electronic medical record. , 1993, Proceedings. Symposium on Computer Applications in Medical Care.

[18]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[19]  Markus Kummer.  Who runs the internet , 2005 .

[20]  Russel L. Thompson,et al.  A Meta-Analysis of Response Rates in Web- or Internet-Based Surveys , 2000 .

[21]  S. Retchin,et al.  Electronic medical record systems at academic health centers: advantages and implementation issues. , 1999, Academic medicine : journal of the Association of American Medical Colleges.

[22]  Chris DiBona,et al.  Open Sources: Voices from the Open Source Revolution , 1999 .

[23]  K E Johnson,et al.  An analysis of trends, perceptions, and use patterns of electronic medical records among US family practice residency programs. , 2000, Family medicine.

[24]  Guy Paré,et al.  Implementing clinical information systems: a multiple-case study within a US hospital , 2002, Health services management research.

[25]  Joan S. Ash,et al.  Factors affecting the diffusion of the Computer-Based Patient Record , 1997, AMIA.

[26]  T. Benson.  Medical software's free future. All software developed at public's expense should be licensed as open source. , 2001, BMJ.

[27]  R. W. Lucky.  Who runs the internet? [Reflections] , 2002 .

[28]  J B Chessare,et al.  Implementation of COSTAR in an academic group practice of general pediatrics. , 1993, M.D. computing : computers in medical practice.

[29]  L. Curry.  The Future of the Public's Health in the 21st Century , 2005 .

[30]  M. Fink,et al.  The Business and Economics of Linux and Open Source , 2002 .

[31]  L. Berkowitz.  Breaking down the barriers. Improving physician buy-in of CPR systems. , 1997, Healthcare informatics : the business magazine for information and communication systems.

[32]  Erik Brynjolfsson,et al.  Technological Change, Computerization, and the Wage Structure , 2000 .

[33]  P W DeBry.  Considerations for choosing an electronic medical record for an ophthalmology practice. , 2001, Archives of ophthalmology.

[34]  Gareth S. Kantor,et al.  Letter to the Editor: Open-source Software and the Primary Care EMR , 2003, J. Am. Medical Informatics Assoc..