Table 1 Overview of Included Studies
Author | Country/region of data Collection | Clinical Area | Expected or Experienced Barriers | Type of Research (Qualitative/Quantitative) | If qualitative | If quantitative | Focus | ||
|---|---|---|---|---|---|---|---|---|---|
| Â | Â | Â | Â | Â | Number of cases/number of physicians involved | Methods for Data Collection | Sample size/sampling strategy/response rate | Data Collection Method | Â |
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 | Â | Â | 1884 stratified/random sample/ 71% | 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 | Â | Â | 2758/ all physicians who provide care from AMA/ 62% | 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 | Â | Â | 4203/ stratified random sample/ 28.2% | Question-naire | All barriers |
Randeree [8] | U.S.A | Orthopedics | 1) cost 2)increase in staff workload 2)supplier presence 3)vendor trust 4)customizability 5)reliability | Qualitative | 3 cases 13 phys | Interview | Â | Â | 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 | Â | Â | 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 | Â | Â | 1181/ stratified random sample/ 71% | Question- naire | 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 | Â | Â | All barriers |
Pizziferri et al. [21] | U.S.A | Outpatient primary care | 1) more time per patient | Qualitative | 5 cases 16 phys | Observation | Â | Â | 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 | Â | Â | Patient-doctor communication |
Walter et al. [22] | U.S.A | All specialties | 1) professional autonomy | Quantitative | Â | Â | 203/ randomly selected/ 34% | Question- naire | Autonomy |
Burt et al. [24] | U.S.A | All specialties | 1) organizational factors of the practice | Quantitative | Â | Â | 3360/ probability sample/ 56% | 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 | Â | Â | 1345/ random sampl/e 71.4% | 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 | Â | Question-naire | All barriers |
Loomis et al. [13] | U.S.A Indiana, | Family care | 1) concerns about data entry 2)costs 3)security and confidentiality 4)lack of belief in EMRs | Quantitative | Â | Â | 618/ all active members of IAFP/ 51.7% | 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 | Â | Â | 227/ random, very small and very large excluded/ 72% | 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 | Â | Â | Sociotechnical barriers |
Valdes et al. [14] | U.S.A | Family care | 1) cost 2)work slowed 3)business failure 4)security concerns 5)standardization | Quantitative | Â | Â | 5517/ all members of AAFP with email addresses/ 15.5% | 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) | Â | Â | Â | Â | All barriers |
Meade et al. [16] | Ireland | All specialties | 1) lack of time 2)cost 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 | Â | Â | 2951/ all Irish GPs/ 64% | 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 | Â | Â | 526/ random sample/ 58% | 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 | Interview Focus group | Â | Â | 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 | Â | Â | 567/practices focus on small practices/ 23% | Question-naire | Organizational learning barriers |