Nearly 79% of primary care physicians are using some form of electronic health record (EHR) in their practices. This number continues to jump significantly from year to year. It surely is a testament to the innovative work that various sectors of the HIT industry have put into adoption efforts. It also speaks to the hard work that has been done by providers and their professional organizations to use Health Information Technology (HIT) tools to improve clinical outcomes for their patients. On the other side of the fence, there remains the 20% of providers who do not have EHRs. Medical Economics reports that, in 2012, among this group 48% said they did not plan to purchase an EHR. This is a 16% increase from 2011. These physicians are often referred to as “EHR holdouts”. Surveys show that most of these providers are the more elder physicians and physicians in small practices.
I am sure the term “hold out” is not meant to be derogatory but it could be interpreted by some that their lack of adoption is simply voluntary. I say it may be voluntary, but probably not that simple. Many physicians struggle to maintain successful practices and in their eyes the EHR is just one of many tools that they cannot afford at this time. It doesn’t mean that the practice is not evidence based or that the providers aren’t caring clinicians who produce good clinical outcomes. It could be that the practice does not have the needed resources whether it’s because of a lack of staffing, management, or money.
I think we have to be careful how we label the minority of physicians that have not yet adopted. Sure there are those who refuse to adopt but others are not able and still put patient care first. Really it’s about patient care and not the technology. More evidence is showing that EHRs are and will aid practices to improve patient outcomes. Hopefully every physician and provider will buy into the technology. However, for those who don’t, we need to have a good understanding of their perspective and adjust our approach to address their barriers and concerns. Every physician or provider who has not adopted may not appreciate the terms “refused to adopt” or “hold out”. Any descriptions of their personal reasoning and practice challenges may be more complicated than these terms suggest. Whatever the barriers may be it shows that there is still work to do.
May you all have an enjoyable, safe and blessed holiday season! Maybe there will be a brand new, shiny, highly functional and user friendly EHR under your tree.