title: Adoption Factors of the Electronic Health Record: A Systematic Review.
abstract: BACKGROUND
  The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures.
  
  
  OBJECTIVE
  The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States.
  
  
  METHODS
  Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012-09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity.
  
  
  RESULTS
  Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues.
  
  
  CONCLUSIONS
  The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates.
authors.affiliation: Texas State University, School of Health Administration, San Marcos, TX, United States. scottkruse@txstate.edu.
authors.forename: Clemens Scott
authors.identifier: http://orcid.org/0000-0002-7636-1086
authors.initials: CS
authors.lastname: Kruse
authors.forename: Krysta
authors.identifier: http://orcid.org/0000-0002-2115-9606
authors.initials: K
authors.lastname: Kothman
authors.forename: Keshia
authors.identifier: http://orcid.org/0000-0002-1277-7621
authors.initials: K
authors.lastname: Anerobi
authors.forename: Lillian
authors.identifier: http://orcid.org/0000-0002-8545-6896
authors.initials: L
authors.lastname: Abanaka
keywords: HITECH Act; electronic health record; health information technology; information technology