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Table 1 Overview of Included Studies

From: Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

Author Country/region of data Collection Clinical Area Expected or Experienced Barriers Type of Research (Qualitative/Quantitative) If qualitative If quantitative Focus
      Number of cases/number of physicians involved Methods for Data Collection Sample size/sampling strategy/response rate Data Collection Method  
Jha et al. [10] U.S.A Massachusetts All specialties 1) computer skills of physicians and/or staff,
2) computer technical support
3)lack of time to acquire system knowledge
4)start-up financial costs
5)ongoing financial costs
6)training and productivity loss
7)physician skepticism
8)privacy or security concerns
Quantitative    1884 stratified/random sample/
Question-naire All barriers
DesRoches et al. [6] U.S.A Direct patient care 1) capital costs
2) not finding a system that meets the needs
3)uncertainty about return on investment
4)concern over system obsolescence
Quantitative    2758/
all physicians who provide care from AMA/
Survey All barriers
Menachemi et al. [11] U.S.A Florida, Ambulatory care 1) upfront cost of hardware/software
2)ongoing maintenance costs
3)inadequate return on investment
4)additional time for data entry
5)no time to acquire/implement such a system
6)slows the work of physicians
7)temporary loss of productivity and/or revenue
8)no time to learn how to use
9)disrupts workflow and/or office's physical layout
10)lack of uniform data standards within the industry
11)temporary loss of access to patient records if computer crashes or power fails
12)products do not meet needs
13)physicians and/or staff lack technical knowledge
14)privacy/confidentiality concerns
Quantitative    4203/
stratified random sample/
Question-naire All barriers
Randeree [8] U.S.A Orthopedics 1) cost
2)increase in staff workload
2)supplier presence
3)vendor trust
Qualitative 3 cases
13 phys
Interview    All barriers
Miller et al. [9] U.S.A Primary care 1) high initial financial costs
2)slow and uncertain financial payback
3)high initial physician time costs
4)complexity of technology
5)more time to learn how to use
6)difficult complementary changes
7)inadequate support
8)inadequate electronic data exchange
9)lack of project champions
10)lack of incentives
Qualitative 90 phys Interview    All barriers
Simon et al. [12] U.S.A Massachusetts Primary care 1) start-up financial costs
2)ongoing financial costs
3)loss of productivity
4)lack of computer skills
5)lack of technical support
6)lack of uniform standards
7)technical limitations of systems
8)concerns about privacy and security
9)organizational size
10)organizational type
11)lack of support from other organizations
Quantitative    1181/
stratified random sample/
All barriers
Davidson et al. [5] U.S.A All specialties 1) cost
2)reluctance to replace a recently acquired system in order to integrate with an EHR
3)uncertainty about the vendor
4)work to convert the records
5)waiting to see if subsidies are offered
Qualitative 26 phys Interview    All barriers
Pizziferri et al. [21] U.S.A Outpatient primary care 1) more time per patient Qualitative 5 cases 16 phys Observation    Time
Shachak et al. [25] Israel Primary care 1) lack of proper typing ability
2)disturbing patient-doctor communication
Qualitative 25 phys Interview + Observa-tion    Patient-doctor communication
Walter et al. [22] U.S.A All specialties 1) professional autonomy Quantitative    203/
randomly selected/
Burt et al. [24] U.S.A All specialties 1) organizational factors of the practice Quantitative    3360/
probability sample/
Question-naire Organiza-tional factors
Simon et al. [27] U.S.A Massachusetts, All specialties 1) organizational size
2) patient privacy concerns
3)lack of time
Quantitative    1345/
random sampl/e
Question-naire All barriers
Earnest et al. [23] U.S.A Clinic for congestive heart failure 1) privacy concerns
2)disturbing patient-doctor communication
Qualitative + Quantitative 7 phys Interview   Question-naire All barriers
Loomis et al. [13] U.S.A Indiana, Family care 1) concerns about data entry
3)security and confidentiality
4)lack of belief in EMRs
Quantitative    618/
all active members of IAFP/
Question-naire All barriers
Laerum et al. [18] Norway All specialties 1) access to computers
2)computer literacy
3)not flexible
4)traditional work routines
Quantitative    227/
random, very small and very large excluded/
Question-naire All barriers
Ludwick et al. [19] Canada Alberta Primary care 1) training and after-sales experience with the vendor
2)technical support from the vendor
3)extra time needed for data entry
4)time constraint in procurement and implementation
5)computer skills of the physicians
6)disruption of the flow of information
Qualitative 9 phys Interview    Sociotechnical barriers
Valdes et al. [14] U.S.A Family care 1) cost
2)work slowed
3)business failure
4)security concerns
Quantitative    5517/
all members of AAFP with email addresses/
Question-naire All barriers
Vishwanath et al. [15] U.S.A All specialties 1) cost issues
2)ROI issues
3)lack of hardware
4)lack of financial incentives
5)logistics and regulatory issues
6)concerns over customization
7)herd mentality/social influence
8)need for control
9)concerns over adopting new technology
10)lack of community level participation
Concept mapping (85 physicians)      All barriers
Meade et al. [16] Ireland All specialties 1) lack of time
3)poor training
4)absence of computer skills
5)lack of financial resources
6)poor typing ability
7) fail to find a suitable system
Quantitative    2951/
all Irish GPs/
Question-naire All barriers
Kemper et al. [17] U.S.A Pediatric 1) expense of implementation
2)inability to find an EHR that meets the requirements
3)inability to interface with existing systems
4)system downtime
5)lack of a clear return on investment
6)transience of vendors
7)increase in physicians' workloads
8)no improvement in patient care or clinical outcomes
9)increase in staff workload
10)staff have inadequate computer skills
11)interference with doctor-patient relationship
12)patient confidentiality
Quantitative    526/
random sample/
Question-naire All barriers
Terry et al. [20] Canada Ontario Primary care 1) time constraints to learn EHR
2) absence of a champion or problem solver
3) too low level of computer experience
Qualitative 50 physicians
Synthesis of three studies
Focus group
   All barriers
Reardon & Davidson [26] USA Hawaii Small practices, majority primary care 1) too little growth and expansion in order to invest in learning, uncertainty in ROI
2) too little knowledge and skills related to EHR
3) too much heterogeneity of organizational knowledge and activities related to EHR
Quantitative    567/practices
focus on small practices/
Question-naire Organizational learning barriers