Barriers to ambulatory EHR: who are 'imminent adopters' and how do they differ from other physicians?

Nir Menachemi


Objective Despite existing knowledge regarding electronic health record (EHR) barriers in the ambulatory setting, little is known, specifically, about physicians who are likely to adopt EHR imminently. The current study identifies these imminent adopters and compares their barriers to other physicians.
Design and measurements Mail survey of Florida physicians (n=14 921) about barriers to EHR and adoption intentions. The survey asked respondents to classify themselves as planning to adopt an EHR system within one year (herein referred to as 'imminent adopters'), as planning to adopt an EHR systembut not within one year ('interested adopters'), and as not considering an EHR system. Chi-square analysis and logistic regression models were used to identify trends among imminent adopters and to compare barriers among respondents in each of the adoption categories above.
Results A total of 4203 returned surveys represented a 28.2% response rate. Imminent adopters were significantly less likely to be in solo practice (19.6% vs. 40.0%, P<0.001) and more likely to be in an urban area (P=0.044) or in a multi-specialty practice (P=0.023). Imminent adopters were also more likely to be practising family medicine (P=0.014) or obstetrics/gyn_cology (P=0.038). When comparedwith their colleagues, imminent adopters perceived EHR barriers very differently. For example, imminent adopters were significantly less likely to consider upfront cost of hardware/software [OR=0.35 (0.30, 0.45)] or that an inadequate return on investment [OR=0.25 (0.19, 0.34)] was a major barrier to EHR. Moreover, imminent adopters differed from their colleagues with respect to numerous other productivity-related and technical-related barriers.
Conclusion Policy and decision makers interested in promoting the adoption of EHR among physicians should focus on the needs and barriers of those most likely to adopt EHR. Given that imminent adopters differ considerably from their peers, current EHR incentive programmes that focus on financial barriers only might prove sub-optimal in achieving immediate widespread EHR adoption.


ambulatory EHR use; barriers; diffusion theory; outpatient EHR

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