1. Exploring Barriers to
Implementing Electronic
Medical Records in
Primary Care Practices
Amrita Parmar
HIMA 5060- Final
Fall 2012-Dr. Zeng

2. Introduction
 Obesity and chronic disease are major concerns faced
by primary care physicians. CDC (Centers of Disease
Control and Prevention) reports one third of the adult
population in the United States is obese (35.7%) 1
 Health conditions are a burden in terms of cost, providing
care, and patient management. 1 Primary care physicians
are first contacts for patients, resulting in health burden
placed upon primacy care physicians 2
 Adoption of health information technology may solve this
increasing pressure2
 Electronic Medical Record (EMR) is a systematic
collection of health information pertaining to individual
patients medical history. 3

3. Background
 Many advantages to implementing EMR found in literature
however, implementation is very low. Only 4% of primary care
providers have fully functional EMR systems and 13% have a
more basic system. 12
 Implementation of EMR systems could lead to efficiency,
quality and quantify of care provided
 Traditional method: paper-based medical record; leading to
space consumption and delay access to medical care. 4
 Paper-based method less efficient due to increase of health
burden and need for care
 The EMR system allows multiple users to access the patient
record creating legible and organized recordings of a
patients medical history. 4

4. Findings
 Barriers to implementing an EMR system in a
primary care practice:
 Financial Cost
 Technology
 Time
 Patient Record Privacy
 Quality of Patient-Physician Interaction

5. Financial Cost
 Physicians weigh the cost of implementing EMR with benefits and return on
investment
 Start-up cost (purchase of hardware and software, installation cost)
 Ongoing cost (technological support, administration of system and maintenance)
 Return on investment is not seen until months into implementation
 Primary care facilities may have to put in a large sum of money at start-up
 McGinn, C. A., et al. (2011) reported 19 (out of 52 studies corresponding to
60 publications) considered cost as a major issue of EMR implementation
in their systematic review
 Training healthcare professionals can require cost to hire system
operations personnel
 Size of practice (smaller primacy care practices may be more reluctant to
implement EMR due to high costs)

6. Technology
 Basic computer skills are necessary in operating an EMR
system
 Primary care physicians may lack technical skills
 Physicians need to quickly record information that the
patient is providing to decrease (or keep the same) the
time spent on each patient, prior to implementation of
the system
 Issues: hardware, server, network malfunctions, system not
providing the promised results can cause delay 7
 Difficulty in reaching support personnel leading to Primary
care physicians getting technical support from other
support agencies at a higher cost. 2

7. Time
 Two parts:
 Physicians believe EMR system will increase time
spent on each patient and the system may not be
as reliable, efficient has completing paper charts.
 Time needed for implementing the EMR system into
the practice and time taken to start using the system
efficiently. Even after implementation access to
technical support, incase issues arise, can also affect
time.

8. Patient Record Privacy
 Primary care physicians concern for patient
record privacy:
 Lack of overall clear security standards that can be
followed upon implementation. 4
 Inappropriate disclosure of medical records leading
to legal issues. 4 McGinn et al. reported that
physicians reported patient record security as the
second most mentioned factor in the systematic
review (21 of the 52 studies). 5

9. Quality of Patient-Physician
Interactions
 Quality of are may decrease due to the use of an
EMR system
 Physicians inputting detailed notes while in the
examination room with the patient
 Impact the amount of attention provided by the
physician to the patient 5
 Paper-based system allows physicians to write as
much or as little and they think necessary
 Loss of individual practice style for the physician
due to following EMR template

10. Conclusions
 In order to meet the needs of an increasingly unhealthy
population, EMR systems need to be implemented
 Barriers faced by primary care practices must be assessed
and successful implementation strategies need to be
found
 Health system stakeholders cannot expect our healthcare
systems to perform if solutions to barriers do not exist. 6
 This paper explored barriers to EMR system
implementation in primary care practices. The barriers
reported on included: financial cost, technology, time,
patient record privacy and quality of patient-physician
interaction.

11. Recommendations
 Financial cost could be government funding or subsidized cost for
practices that treat Medicare and or Medicaid patients
 Primary care physicians that provide care to state or federal plan carriers
could be compensated for implementing EMR systems. 4
 EMR system developing companies, offering better customer support,
could resolve technological issues
 Primary care physicians should look into systems that are best suited for
their practice.
 Patient privacy can be protected under the Health Insurance Portability
and Accountability Act (HIPPA). 4 This act can protect the handing and
transporting of health records from physician to patient, one medical
facility to another, or anywhere where records need to be transported
 Physician patient interaction can be improved by proper position of
monitor in the examination room
 If funds are available purchasing a tablet could be effective in entering
data while providing care to patients

12. References
 The Centers of Disease Control and Prevention. (2012). Overweight and Obesity. Adult Obesity Facts. Retrieved from: http://www.cdc.gov/obesity/data/adult.html
1
 Ludwick, D. A., and Doucette, J.(2009). Primary Care Physicians’ Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service
2
Environment. International Journal of Telemedicine and Applications. 853524(9). Retrieved from: http://www.hindawi.com/journals/ijta/2009/853524/
 3
Vanek, V. W.,(2012). Providing Nutrition Support in the Electronic Health Record Era: The Good, the Bad, and the Ugly. Nutritional in Clinical Practice. 27(718). Retrieved
from: http://ncp.sagepub.com/content/27/6/718.full.pdf+html
 Boonstra, A. and Broekhuis, M.,(2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions.
4
BMC Health Services Research. 10(231). Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334/pdf/1472-6963-10-231.pdf
 McGinn, C. A. et al.,(2011).Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC
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