title: Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange.
abstract: BACKGROUND
  The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption.
  
  
  OBJECTIVE
  We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows.
  
  
  METHODS
  Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score.
  
  
  RESULTS
  A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger.
  
  
  CONCLUSIONS
  At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians.
authors: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland. Electronic address: sima.djalali@usz.ch.
authors: Sima
authors: S
authors: Djalali
authors: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors: Nadine
authors: N
authors: Ursprung
authors: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors: Thomas
authors: T
authors: Rosemann
authors: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors: Oliver
authors: O
authors: Senn
authors: Institute of Primary Care, University of Zurich, University Hospital Zurich, Switzerland.
authors: Ryan
authors: R
authors: Tandjung
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D066275:Health Information Exchange; D006801:Humans; D016015:Logistic Models; D008297:Male; D008490:Medical Informatics / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013557:Switzerland; D057188:Workflow
keywords: Ambulatory care; Barriers; Electronic health record; Health information technology; Implementation; Switzerland