title: Fundamental issues in implementing an ambulatory care electronic health record.
abstract: BACKGROUND
  The use of a fully functional electronic health record (EHR) system is linked to improved quality measures. However, almost half of ambulatory providers with an EHR do not use the full functionality. Attempts to encourage optimal use of EHRs must address barriers associated with the need to change medical practice.
  
  
  METHODS
  Our primary research question was, what are the fundamental issues associated with the need to change medical practice that created barriers to electronic health record (EHR) implementation and use? In this qualitative study we analyzed the data from 47 interviews with administrative and physician informants and 6 focus groups including 35 practicing physicians across 6 health care organizations that were deemed to be successful with ambulatory EHR implementation.
  
  
  RESULTS
  Comments from informants revealed 6 fundamental issues: (1) need to change practice style; (2) threat to professionalism; (3) shift of expertise; (4) required changes to interactions with patients; (5) concern about the impact on medical education and training; and (6) concern about effects on clinical care.
  
  
  CONCLUSIONS
  The physician experience must be at the forefront of efforts to increase the rate of ambulatory physician use of the full functionalities of an EHR. The issues highlighted here illuminate potential points of intervention when engaging physicians to ensure optimal use of EHRs.
authors.affiliation: From the Departments of Family Medicine (ASM, JLH, CS, MR, TRH) and Biomedical Informatics (MR, TRH), The Ohio State University College of Medicine, Columbus; the Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus (ASM); and the Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (ASM). Ann.McAlearney@osumc.edu.
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.affiliation: From the Departments of Family Medicine (ASM, JLH, CS, MR, TRH) and Biomedical Informatics (MR, TRH), The Ohio State University College of Medicine, Columbus; the Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus (ASM); and the Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (ASM).
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hefner
authors.affiliation: From the Departments of Family Medicine (ASM, JLH, CS, MR, TRH) and Biomedical Informatics (MR, TRH), The Ohio State University College of Medicine, Columbus; the Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus (ASM); and the Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (ASM).
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sieck
authors.affiliation: From the Departments of Family Medicine (ASM, JLH, CS, MR, TRH) and Biomedical Informatics (MR, TRH), The Ohio State University College of Medicine, Columbus; the Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus (ASM); and the Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (ASM).
authors.forename: Milisa
authors.initials: M
authors.lastname: Rizer
authors.affiliation: From the Departments of Family Medicine (ASM, JLH, CS, MR, TRH) and Biomedical Informatics (MR, TRH), The Ohio State University College of Medicine, Columbus; the Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus (ASM); and the Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland (ASM).
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Huerta
mesh_terms: D000553:Ambulatory Care; D004501:Education, Medical; D057286:Electronic Health Records; D006284:Health Plan Implementation; D006801:Humans; D024382:Professional Role
keywords: Electronic Medical Records; Practice Management; Qualitative Research