title: Barriers to electronic health record use during patient visits.
abstract: The effectiveness of electronic health record (EHR)-based clinical decision support is limited when clinicians do not interact with the EHR during patient visits. To assess EHR use during ambulatory visits and determine barriers to such use, we performed a cross-sectional survey of 501 primary care clinicians. Of 225 respondents, 53 (24%) never or only sometimes used any EHR functionality during patient visits. Non-physician clinicians (e.g., nurse practitioners) were marginally more likely to be EHR non-users than physicians (39% versus 21%, respectively; p = .05). The most commonly reported barriers to using the EHR during patient visits were loss of eye contact with patients (62%), falling behind schedule (52%), computers being too slow (49%), inability to type quickly enough (32%), feeling that using the computer in front of the patient is rude (31%), and preferring to write long prose notes (28%). EHR developers and healthcare system leaders must address social, workflow, technical, and professional barriers if clinicians are to use EHRs in the presence of patients and realize the full potential of ambulatory clinical decision support.
authors.affiliation: Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Ruslana
authors.initials: R
authors.lastname: Tsurikova
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Melnikas
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003430:Cross-Sectional Studies; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D009722:Nurse Practitioners; D010817:Physician-Patient Relations; D010821:Physicians, Family