Electronic medical records adoption and use: Understanding the barriers and the levels of adoption for physicians in the USA

Abstract

The aim of this research is to explore the motives behind the adoption or rejection of Electronic Health Records (EHR) systems in the USA by medical offices. The current health care system in the United States suffers from high expenditures and poor quality. The Patient Protection and Affordable Care Act, passed in 2010, attempts to save costs and improve quality of care by offering incentives to use Electronic Health Records systems. Part of the reform by this law is dependent on the use of technology in managing patient medical and health records. The objective is to reduce redundancy and increase quality by sharing medical information amongst different health organizations like hospitals, physician offices, laboratories and clinical institutions. The success of such reform requires the participation and collaboration of all these entities and their patients. Prior research shows that adoption of Electronic Medical Records systems by hospitals and physician offices has been evident but at a rate that is slower than in other countries. Aside from financial barriers, technical, psychological, social/legal and organizational barriers exist. In order to understand the impact of those barriers on the adoption of Electronic Health Records management by small physician offices better, a five-level adoption model is presented to define the stages of diffusion of EHR systems. Fifteen consolidated barriers are mapped to each adoption level. This research concentrates on smaller physician offices because hospitals and larger institutions are more ready and capable of adoption, according to previous research. The Diffusion of Technology Model by Rogers, the Theory of Planned Behavior by Ajzen and Fishbein, and Davis' Technology Acceptance Model are combined and extended. This model will be used to empirically measure physicians' attitudes, knowledge, social and legal influences, subjective norm and systems' ease of use and usefulness amongst other variables. These variables are applied as mediators or moderators of the intention and decision to adopt or move into subsequent levels of adoption with the goal of seeing what drives those decisions.