What stands in the way of technology-mediated patient safety improvements?: a study of facilitators and barriers to physicians' use of electronic health records

Abstract

Objectives: For electronic health record (EHR) systems to have a positive impact on patient safety, clinicians must be able to use these systems effectively after they are made available. This study's objective is to identify and describe facilitators and barriers to physicians' use of EHR systems.

Methods: Twenty research interviews were conducted with attending physicians who were using EHR at 1 of 2 Midwest community hospitals and/or at their respective outpatient clinics.

Results: Analyses yielded more than 200 perceived facilitators and barriers, comprising 19 distinct categories. Categories of facilitators/barriers related to user attribute included learning, typing proficiency, understanding the EHR system, motivation/initiative, and strategies/workarounds. Categories related to system attributes were supporting hardware/software and system speed, functionality, and usability. Categories related to support from others were formal technical support, formal training, and informal support from colleagues. Categories of organizational facilitators/barriers were time allowance and interinstitutional integration. Categories of environmental facilitators/barriers were physical space, electricity, wireless connectivity, and the social environment.

Conclusions: Together, the broad set of discovered facilitators and barriers confirms and expands prior research on the facilitators and barriers to health information technology use. The depth of reported information on each facilitator and barrier made possible by qualitative interview methods contributes to the theoretical understanding of facilitators and barriers to EHR use. Equally as important, this study provides an information base from which relevant policy and design interventions can be launched to improve the use of EHR systems and, thus, patient safety.

Figure 1

After an organization adopts electronic health records (EHR), clinicians accept or reject and use or do not use EHR and these post-adoption attitudes and behavior determine outcomes of interest such as quality of care, patient safety, and return on investment. Facilitators and barriers, among other causal factors, influence adoption, acceptance and use, and outcomes of interest.