Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities. <s> BIB001 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> To achieve the goal of comprehensive health information record keeping and exchange among providers and patients, hospitals must have functioning electronic health record systems that contain patient demographics, care histories, lab results, and more. Using national survey data on US hospitals from 2011, the year federal incentives for the meaningful use of electronic health records began, we found that the share of hospitals with any electronic health record system increased from 15.1 percent in 2010 to 26.6 percent in 2011, and the share with a comprehensive system rose from 3.6 percent to 8.7 percent. The proportion able to meet our proxy criteria for meaningful use also rose; in 2011, 18.4 percent of hospitals had these functions in place in at least one unit and 11.2 percent had them across all clinical units. However, gaps in rates of adoption of at least a basic record system have increased substantially over the past four years based on hospital size, teaching status, and location. Small, nonteaching, and rural hospitals continue to adopt electronic health record systems more slowly than other types of hospitals. In sum, this is mixed news for policy makers, who should redouble their efforts among hospitals that appear to be moving slowly and ensure that policies do not further widen gaps in adoption. A more robust infrastructure for information exchange needs to be developed, and possibly a special program for the sizable minority of hospitals that have almost no health information technology at all. <s> BIB002 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> OBJECTIVE ::: In an effort to understand better the federal electronic health record (EHR) incentive programme's challenges, this study compared hospitals that did and did not receive meaningful use (MU) payments in the programme's first year based on the challenges they anticipated a year before. ::: ::: ::: MATERIALS AND METHODS ::: This cross-sectional study used 2010 American Hospital Association survey data and 2011 Centers for Medicare and Medicaid Services data that identify hospitals receiving MU payments. Multivariate regression analysis assessed differences in 2010 anticipated challenges to MU for hospitals that were successful in earning 2011 MU payment compared to hospitals that intended to participate in the programme but were not yet successful. ::: ::: ::: RESULTS ::: The study sample consisted of 2475 hospitals, 313 of which received MU payments in 2011. Controlling for standard hospital characteristics, hospitals that reported the computerized provider order entry (CPOE) MU criterion as a primary challenge were 18% less likely to receive a 2011 MU payment compared to hospitals that reported other criteria as primary challenges. ::: ::: ::: DISCUSSION ::: CPOE was the main challenge among hospitals that failed to achieve MU in the first year of the programme. In order to maximize the incentive programme's effectiveness, policymakers, healthcare organizations, and EHR vendors may benefit from increased attention to hospitals' challenges with CPOE. ::: ::: ::: CONCLUSION ::: As the EHR incentive programme matures, policymakers and other stakeholders should consider strategies that maintain the critical elements of MU while adequately supporting hospitals that desire to become MU but are impeded by specific technological, cultural, and organizational adoption and use challenges. <s> BIB003 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Background Health information technology (HIT) certification and meaningful use are interventions encouraging the adoption of electronic health records (EHRs) in the USA. However, these initiatives also constitute a significant intervention which will change the structure of the EHR market. ::: ::: Objective To describe quantitatively recent changes to both the demand and supply sides of the EHR market. ::: ::: Materials and methods A cohort of 3447 of hospitals from the HIMSS Analytics Database (2006–10) was created. Using hospital referral regions to define the local market, we determined the percentage of hospitals using paper records, the number of vendors, and local EHR vendor competition using the Herfindahl–Hirschman Index. Changes over time were assessed using a series of regression equations and geographic information systems analyses. ::: ::: Results Overall, there was movement away from paper records, upward trends in the number of EHR vendors, and greater competition. However, changes differed according to hospital size and region of the country. Changes were greatest for small hospitals, whereas competition and the number of vendors did not change dramatically for large hospitals. ::: ::: Discussion The EHR market is changing most dramatically for those least equipped to handle broad technological transformation, which underscores the need for continued targeted support. Furthermore, wide variations across the nation indicate a continued role for states in the support of EHR utilization. ::: ::: Conclusion The structure of the EHR market is undergoing substantial changes as desired by the proponents and architects of HIT certification and meaningful use. However, these transformations are not uniform for all hospitals or all the country. <s> BIB004 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. <s> BIB005 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> OBJECTIVE ::: To determine rates of electronic health record (EHR) adoption and health information exchange (HIE) among New York State (NYS) nursing homes. ::: ::: ::: DATA SOURCES/STUDY SETTING ::: Primary data collected from a novel survey administered between November 2011 and March 2012 to all NYS nursing homes. ::: ::: ::: STUDY DESIGN ::: We used a cross-sectional study design to assess level of EHR implementation, automation of key functionalities, participation in HIE, and barriers to adoption. ::: ::: ::: DATA COLLECTION/EXTRACTION METHODS ::: We used descriptive statistics to characterize rates of EHR adoption and participation in HIE and logistic regression to identify nursing home characteristics associated with EHR adoption and HIE. ::: ::: ::: PRINCIPAL FINDINGS ::: We received responses from 375 of 632 nursing homes (59.3 percent). Of respondents, almost one in five (n=66, 18.0 percent) reported having a fully implemented and operational EHR and a majority (n=192, 54.4 percent) reported electronically exchanging information. Nursing homes with 100-159 beds were significantly less likely than other facilities to have implemented or be in the process of implementing an EHR (p=.011). ::: ::: ::: CONCLUSIONS ::: Our findings present an important systematic look at EHR adoption and HIE by NYS nursing homes. Although the nursing home sector has been reported to lag in health information technology adoption, our results are encouraging. However, they suggest much room for growth and highlight the need for targeted initiatives to achieve more widespread adoption in this important health care sector. <s> BIB006 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate indepe... <s> BIB007 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> OBJECTIVES ::: Federal policies are incentivizing hospitals and providers to adopt and meaningfully use electronic health records (EHRs). Nursing homes are not eligible for incentives. However, understanding health information technology (HIT) adoption among nursing homes will be critical to developing HIT policies for this sector. Our objective was to assess the pace of EHR adoption, changes in computerized function adoption, and participation in health information exchange by New York state nursing homes over time. ::: ::: ::: STUDY DESIGN ::: We used a repeated, cross-sectional study design. ::: ::: ::: METHODS ::: We surveyed all New York state nursing homes between February and May 2013, comparing results to the same survey administered in 2012. ::: ::: ::: RESULTS ::: We received responses from 472 of 630 nursing homes (74.9%). Rates of EHR adoption increased from 48.6% to 56.3% (P = .03). Participation in health information exchange remained unchanged (54.5% to 55.3%, P = .8). The top barriers to EHR adoption cited were: a) the initial cost of HIT investment (67.9%, n = 133), b) lack of technical IT staff (46.4%, n = 91), and c) lack of fiscal incentives (45.8%, n = 88). Comparing nursing homes with EHRs in 2012 to nursing homes with EHRs in 2013, the availability of many types of computerized functionalities significantly increased, although no gains were seen for order entry or clinical tools. ::: ::: ::: CONCLUSIONS ::: While some gains are being made by nursing homes, HIT adoption generally lags behind that of other sectors. Public policy focusing on building HIT infrastructure is essential to ensure that nursing homes keep up with other healthcare segments. <s> BIB008 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Electronic health records (EHRs), intended to improve the clinical process, are understudied in home care. The researchers assessed clinician satisfaction, informed by workflow and patient outcomes, to identify EHR adoption challenges. The mixed methods study setting was a Philadelphia agency with 137 clinicians. Adoption challenges included: (a) hardware problems coupled with lack of field support; (b) inadequate training; and (c) mismatch of EHR usability/functionality and workflow resulting in decreased efficiency. Adoption facilitators were support for team communication and improved clinical data timeliness. Opportunities for improved adoption included sharing with front-line clinicians EHR data related to patient care and health outcomes. <s> BIB009 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Adoption of electronic health record systems in healthcare has been relatively slow. This article proposes critical success factors for electronic health record adoption based on a comprehensive literature review and prescriptive analysis. The proposed 26 critical success factors for electronic health records are of value to both practice and research: practitioners are offered guidance with regard to managing electronic health record implementations toward adoption success, while researchers are offered a basis for further research about electronic health record implementation and adoption. <s> BIB010 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others. Physicians' electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention. <s> BIB011 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Federal electronic health record (EHR)-related initiatives are leading to rapid increases in their adoption. Despite their benefits, EHRs also introduce new risks that can lead to serious safety events. We conducted a Web-based survey of the American Society for Healthcare Risk Management and the American Health Lawyers Association to elicit perceptions regarding the frequency and types of EHR-related serious safety events. We received 369 responses. The majority (66%) worked for large hospitals and health systems with varying degrees of EHR adoption. More than half (53%) of respondents reported at least one EHR-related serious safety event in the previous 5 years, and 10% reported more than 20 events. EHR workflow (63%), user familiarity with the EHR system (63%), and integration with existing systems (59%) were most frequently endorsed as variables associated with EHR-related serious safety events. Because EHR-related safety concerns are underreported, organizations should consider implementing robust measures of EHR safety within their institution as a key step for mitigating these concerns. <s> BIB012 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> Implementation of electronic health records (EHRs) has historically been lower among obstetrician-gynecologists (ob-gyns) than many physician groups. This study described ob-gyns' adoption and use of EHR systems in practice, as well as barriers and benefits to implementation. Surveys asking about the physicians' use of EHR, satisfaction with systems, and what features they found most or least helpful were mailed to 1,200 ob-gyns. An overall response rate of 57.4% was achieved, with 559 returning completed surveys. Over three-quarters of responders reported that they used an EHR system or planned to implement one. Physicians without EHR tended to be older, were more likely to be male, have a solo practice, and describe themselves as Asian/Pacific Islander. Over 63% of those physicians who use EHR reported being satisfied with their system, while 30.8% were not satisfied. Ob-gyns who reported satisfaction had a younger mean age (M = 52.98, SD = 8.87) than those not satisfied (M = 56.30, SD = 8.59; p = .002). Use of EHR systems among ob-gyns has increased in recent years and overall satisfaction with these systems is high. In spite of this, barriers to implementation are still present and increased outreach to certain groups of ob-gyns, including older practitioners and those in solo practices, is needed. <s> BIB013 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> OBJECTIVES ::: The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. ::: ::: ::: SETTING ::: We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. ::: ::: ::: PARTICIPANTS ::: Search results were filtered by date range, full text, English language and academic journals (n=22). ::: ::: ::: INTERVENTIONS ::: Multiple members of the research team read each article to confirm applicability and study conclusions. ::: ::: ::: PRIMARY AND SECONDARY OUTCOME MEASURES ::: Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. ::: ::: ::: RESULTS ::: Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. ::: ::: ::: CONCLUSIONS ::: Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. <s> BIB014 </s> Barriers to Electronic Health Record Adoption: a Systematic Literature Review <s> Results of Individual Studies and Additional Analysis <s> BACKGROUND ::: The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. ::: ::: ::: OBJECTIVE ::: The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. ::: ::: ::: METHODS ::: Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012-09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. ::: ::: ::: RESULTS ::: Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. ::: ::: ::: CONCLUSIONS ::: The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates. <s> BIB015
The initial cost of implementing a system is consistently considered a top, major barrier to the implementation of electronic health record systems appeared 14. 4 % of all occurrences (18/ 125) BIB001 BIB005 BIB006  BIB007 BIB002 BIB003 BIB004 BIB008 BIB009  BIB013  BIB014 BIB015 BIB010   . Technical support appeared 8.0 % of all occurrences (10/125)  BIB001 BIB006  BIB007 BIB004 BIB008  BIB014 BIB015 . Technical concerns appeared 7.2 % of all occurrences (9/125) BIB011  BIB008  BIB013  BIB014 BIB015 BIB010 . Maintenance/ongoing costs [10-12, 17, 18, 20, 22, 24] and resistance to changing work habits  BIB012  BIB013  BIB014 BIB015 BIB010 occurred 6.4 % of all occurrences (8/125). Training appeared 5.6 % of all occurrences (7/125) [11-14, 19, 22, 24] . Next were insufficient time BIB001 BIB004  BIB014 BIB015 , privacy concerns BIB011 BIB006 BIB012 BIB015 BIB010 , and workflow challenges BIB012 BIB007 BIB008 BIB013  which each appeared 4.0 % of all occurrences (5/125). Financial incentives BIB012 BIB007 BIB008 BIB013 and productivity loss   BIB013  times or less among the sample, and we judged these to be of minor significance and not worth greater scrutiny.