Factors and Forces Affecting Ehr System Adoption: Report of a 2004 Acmi Discussion
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Position Paper j ASH, BATES, EHR System Adoption
Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion
JOAN S. ASH, PHD, DAVID W. BATES, MD, MSC Abstract
After the first session of the American College of Medical Informatics 2004 retreat, during which the history of electronic health records was reviewed, the second session served as a forum for discussion about the state of the art of EHR adoption. Adoption and diffusion rates for both inpatient and outpatient EHRs are low for a myriad of reasons ranging from personal physician concerns about workflow to broad environmental issues. Initial recommendations for addressing these issues include providing communication and education to both providers and consumers and alignment of incentives for clinicians. J Am Med Inform Assoc. 2005;12:8–12. DOI 10.1197/jamia.M1684.
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This report explores the gap between where we are now concerning adoption of the electronic health record (EHR), where American College of Medical Informatics (ACMI) members believe we should be, why the gap exists, and what can be done about it. The factors and forces influencing electronic health record adoption in the United States differ between the inpatient and outpatient setting, but the differences represent variations in the strength of the forces rather than the type. Adoption rates are low in both settings, except for specific sectors. Furthermore, diffusion rates appear to be low. We explore the reasons for this in depth, and present possible strategies for decreasing the inhibiting factors and strengthening the facilitating forces.
Adoption
Several studies of EHR adoption in the inpatient setting describe rates less than 10%1-3 if computerized physician order entry is used as a proxy for the electronic health record. Usage of systems that display laboratory or radiology results seems to be much more widespread. It could be debated whether CPOE is a reasonable proxy since obviously the EHR
Position Paper j ASH, BATES, EHR System Adoption
Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion
JOAN S. ASH, PHD, DAVID W. BATES, MD, MSC Abstract
After the first session of the American College of Medical Informatics 2004 retreat, during which the history of electronic health records was reviewed, the second session served as a forum for discussion about the state of the art of EHR adoption. Adoption and diffusion rates for both inpatient and outpatient EHRs are low for a myriad of reasons ranging from personal physician concerns about workflow to broad environmental issues. Initial recommendations for addressing these issues include providing communication and education to both providers and consumers and alignment of incentives for clinicians. J Am Med Inform Assoc. 2005;12:8–12. DOI 10.1197/jamia.M1684.
j
This report explores the gap between where we are now concerning adoption of the electronic health record (EHR), where American College of Medical Informatics (ACMI) members believe we should be, why the gap exists, and what can be done about it. The factors and forces influencing electronic health record adoption in the United States differ between the inpatient and outpatient setting, but the differences represent variations in the strength of the forces rather than the type. Adoption rates are low in both settings, except for specific sectors. Furthermore, diffusion rates appear to be low. We explore the reasons for this in depth, and present possible strategies for decreasing the inhibiting factors and strengthening the facilitating forces.
Adoption
Several studies of EHR adoption in the inpatient setting describe rates less than 10%1-3 if computerized physician order entry is used as a proxy for the electronic health record. Usage of systems that display laboratory or radiology results seems to be much more widespread. It could be debated whether CPOE is a reasonable proxy since obviously the EHR
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