Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions
Open accessAbstract
BACKGROUND: The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options. METHODS: A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information. RESULTS: The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers. CONCLUSIONS: Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.
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Many studies described a need for recognised standards for the provision of e-health systems.
“The need for recognised standards for the provision of e-health systems was described by many studies [16, 18, 20, 28, 33, 36, 48, 49, 51].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Absence or inadequacy of legislation and policies and liability concerns may hamper the implementation of e-health systems at the organisational and health professional level.
“An absence or inadequacy of legislation and policies and liability concerns may hamper the implementation of e-health systems at the organisational and health professional level [17, 18, 20, 51].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Incentives by government organisations and other external stakeholders may facilitate adoption of e-health by healthcare organisations.
“Incentives by government organisations and other external stakeholders may facilitate adoption by healthcare organisations [17, 18, 39, 48, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
The fit between e-health systems and workflows was discussed by the majority of studies.
“The fit between e-health systems and workflows in particular was discussed by the majority of studies [15, 16, 18, 21, 23, 25, 27, 28, 36, 40, 41, 43, 47–50, 52, 55–58].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
A lack of leadership involvement can be a barrier to implementation.
“and a lack of involvement can be a barrier to implementation [18, 53].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Quality of project management, careful study of downstream effects on workflow, additional training, adaptability of technologies to fit with roles/tasks/workflows, and dedicated technical support staff are suggested as strategies to reduce barriers related to disruptions to workflow, roles and responsibilities.
“The quality of project management during the implementation period [18], careful study of the downstream effects of implementation on workflow [55], additional training [31, 55], the adaptability of technologies to fit with roles, tasks and workflows [37] and dedicated technical support staff [31] are suggested as strategies to reduce barriers related to disruptions to workflow, roles and respons”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Access to appropriate, high-quality, well-funded, and easily available training was reported as a facilitator to implementation, whereas non-existent or inadequate training was reported as a barrier.
“Generally, access to appropriate, high-quality, well-funded, and easily available training was reported as a facilitator to implementation, whereas it was reported as a barrier when it was non-existent or existent but inadequate [15, 16, 18, 20, 23, 25, 28, 31, 37, 43, 45, 50, 51, 53–58].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Physician resistance to e-health implementation is related to fear of, dissatisfaction with, and uncertainty over new roles and responsibilities created by the introduction of e-health systems.
“Physician resistance to e-health implementation is reported by several studies to be related to fear of [18], dissatisfaction with [18] and uncertainty over [43, 47] new roles and responsibilities, created by the introduction of e-health systems [18].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
The designation of champions may be important for implementation success.
“The designation of champions [18, 20, 25, 29, 31, 32, 36, 37, 39, 51, 54, 58] may be important for implementation success.”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Fears over loss of autonomy, concerns about liability, concerns over patient privacy and security being compromised, and perceived threats to patient and health professional relationships through the introduction of e-health systems were repeatedly reported as barriers to use.
“Specifically, fears over a loss of autonomy [16, 18, 27, 34, 37, 39, 43], concerns about liability [16, 18, 22, 37, 43, 51], concerns over patient privacy and security being compromised [16, 18, 20, 23, 24, 27, 28, 30, 31, 33, 39, 41, 43, 45, 47, 49, 51–53, 56, 57], and perceived threats to patient and health professional relationships [18, 25, 27, 28, 31, 34, 37–39, 41, 43, 54, 57] through the”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
The work of planning includes delineation of roles and responsibilities, securing time for system selection and procurement, evaluating concomitant policy and process changes, needs assessment and analysis, development of a business plan, early identification and engagement of champions, involving end users, establishing a guiding philosophy, testing organisational readiness, development of incent
“The work of planning includes the delineation of roles and responsibilities [43], securing time to invest system selection and procurement [18], evaluating other concomitant policy and process changes [40], needs assessment and analysis, development of a business plan [44], early identification and engagement of champions [31], involving end users [16, 27, 41, 51], establishing a guiding”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
Healthcare professionals' computer skills, abilities, and experience were cited by several studies as influencing implementation and acceptance of e-health systems.
“Healthcare professionals’ computer skills, abilities and experience were cited by several studies as influencing implementation and acceptance of e-health systems [16, 18, 25, 28, 34, 36, 37, 41, 43, 52, 57].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [18]
The current evidence base on electronic record implementation is dominated by studies from the US.
“However, the current evidence base is dominated by studies from the US and given the major differences in the social, political and economic foundations of their healthcare system, it is important to explore whether these issues are relevant in other contexts.”
From Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory (2017) · cites this paper as [8]
Empirical evidence that explores the benefits, barriers and disadvantages of implementing electronic records has recently been summarised in a systematic review of 22 studies, which identified technical issues alongside financial and time constraints as the most frequently reported barriers associated with electronic record implementation.
“Empirical evidence that explores the benefits, barriers and disadvantages of implementing electronic records has recently been summarised in a systematic review [8] of 22 studies, which identified technical issues alongside financial and time constraints as the most frequently reported barriers associated with electronic record implementation.”
From Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory (2017) · cites this paper as [8]
Of the 93 papers, 57 targeted EHR/EMR, and telemedicine/telehealth was the second most popular application studied (7/93).
“The 93 papers addressed a wide range of eHealth applications. 57 targeted the EHR/EMR, which was defined as computerized medical information systems that collect, store, and display patient information [24].”
From Health Care Provider Adoption of eHealth: Systematic Literature Review (2013) · cites this paper as [24]
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- Authors
- Boonstra, A., & Broekhuis, M.
- Affiliations
- University of Groningen (NL)
- Corresponding author
- Boonstra, Albert
- Venue
- BMC Health Services Research
- Published
- 2010-08-06
- Volume
- 10
- Issue
- 1
- Pages
- 231-231
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2924334
- OpenAlex
- W2155857546
- Cited by
- 851
- References
- 34
- Citations by year
- 2026: 30 · 2025: 36 · 2024: 47 · 2023: 46 · 2022: 75 · 2021: 41 · 2020: 48 · 2019: 54 · 2018: 69 · 2017: 63 · 2016: 56 · 2015: 73 · 2014: 67 · 2013: 68 · 2012: 40
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Social Sciences › Business, Management and Accounting › Management Information Systems › ERP Systems Implementation and Impact
- Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
- Keywords
- electronic health records, physician acceptance, technology adoption barriers, EMR implementation, change management, organizational barriers, financial barriers, legal barriers, social barriers, psychological barriers, time barriers, technical challenges, implementation strategies, medical practice
- MeSH terms
- Attitude to Computers, Diffusion of Innovation, Humans, Physicians, Electronic Health Records
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