title: Understanding differences in electronic health record (EHR) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care.
abstract: OBJECTIVE
  Electronic health records (EHR) hold great promise for managing patient information in ways that improve healthcare delivery. Physicians differ, however, in their use of this health information technology (IT), and these differences are not well understood. The authors study the differences in individual physicians' EHR use patterns and identify perceptions of uncertainty as an important new variable in understanding EHR use.
  
  
  METHODS
  Qualitative study using semi-structured interviews and direct observation of physicians (n=28) working in a multispecialty outpatient care organization.
  
  
  METHODS
  We identified physicians' perceptions of uncertainty as an important variable in understanding differences in EHR use patterns. Drawing on theories from the medical and organizational literatures, we identified three categories of perceptions of uncertainty: reduction, absorption, and hybrid. We used an existing model of EHR use to categorize physician EHR use patterns as high, medium, and low based on degree of feature use, level of EHR-enabled communication, and frequency that EHR use patterns change.
  
  
  RESULTS
  Physicians' perceptions of uncertainty were distinctly associated with their EHR use patterns. Uncertainty reductionists tended to exhibit high levels of EHR use, uncertainty absorbers tended to exhibit low levels of EHR use, and physicians demonstrating both perspectives of uncertainty (hybrids) tended to exhibit medium levels of EHR use.
  
  
  CONCLUSIONS
  We find evidence linking physicians' perceptions of uncertainty with EHR use patterns. Study findings have implications for health IT research, practice, and policy, particularly in terms of impacting health IT design and implementation efforts in ways that consider differences in physicians' perceptions of uncertainty.
authors.affiliation: South Texas Veterans Health Care System, Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT), Austin, Texas, USA.
authors.forename: Holly Jordan
authors.initials: HJ
authors.lastname: Lanham
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parchman
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Pugh
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel
mesh_terms: D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D035501:Uncertainty
keywords: ambulatory care; complexity science; electronic health record use; physician perceptions of uncertainty; uncertainty management