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


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/

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

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

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

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/

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

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/

34%

Question-

naire

Autonomy


Burt et al. [24]

U.S.A

All specialties

1) organizational factors of the practice

Quantitative

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

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

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

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

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

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

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)

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

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

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

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/

23%

Question-naire

Organizational learning barriers


Boonstra and Broekhuis BMC Health Services Research 2010 10:231   doi:10.1186/1472-6963-10-231

Open Data