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Solving the $20 Billion Problem of Electronic Medical Records

McCombs TODAY is highlighting research that will be discussed at the Innovation in Health Care Delivery Systems Symposium, including this perspective from Holly Lanham, Ph.D. student and Reuben McDaniel, Jr., professor of information management.

Insurance coverage has taken center stage in healthcare reform conversations, but another big change is also a hot topic in the industry: electronic medical records. The recent stimulus bill earmarked $20 billion for healthcare IT. Many argue it's key to improving health care, but others are hesistant to start using new technologies.

McCombs researchers have taken an in-depth look at the differences in how physicians use electronic health records and have developed new insights into the challenge of universal adoption. Lanham and McDaniel's research, titled "Heterogeneity in Electronic Health Record Use: Information Technology Use as Influenced by Professional Values and Perspectives on Uncertainty," draws attention to two variables important in understanding differences between physicians in electronic health records use: their professional values and the way they think about uncertainty in medicine.

“Electronic health records are an important information technology in the health care sector and acceptance of this IT over the past decade has been surprisingly problematic, particularly in small practices where most Americans receive care,” says Lanham. The first connection to use of electronic records is how doctors view their practice and relationship to others.

“The set of professional values that physicians bring with them is important in understanding how they use electronic health records,” says Lanham. “This may sound obvious, but little research addresses the problem of information technology use in this way.”

Lanham classified patterns of electronic health record use into three categories — high, medium and low. She found that physicians with professional values that were patient-oriented and organization-oriented tended to use electronic health records more often than physicians whose values were profession-oriented only. In addition, physicians who held more than one of those values at the same time were higher users than physicians who held only one core value.

How doctors viewed uncertainty also played a role in how they used the system. Physicians who viewed uncertainty as reducible through information were higher users of electronic health records, while physicians who subscribed to the concept of fundamental uncertainty — uncertainty that cannot be reduced through information — were lower users.

"I don’t see this as a problem of adoption; I see this as a problem of use," says Lanham. "In this research, I wanted to take a step back and really observe how doctors were using electronic health records. We know a lot about who is adopting electronic health records and who is using these systems, but we know relatively little about how physicians are using these systems in practice. Research has uncovered relationships between perceived usefulness, perceived ease of use, age, gender, etc. on information technology use, but much of the existing work in this area looks at intention to use information technology as opposed to actual IT use.

“A challenge that arises from these findings is that both of these variables are sticky, or difficult to change," says Lanham. "And that’s for any individual. Now add to the equation the fact that physicians are professionals.

"Rather than focusing all of our attention on trying to standardize how physicians use electronic health records, perhaps efforts to leverage this IT should start by acknowledging that physicians are different from one another in some important ways. If we can accept these differences as inherent and think about them as potentially beneficial, then we can focus on aggressively pursuing designs, implementation strategies, management practices and policies that accommodate these differences. I see this as a real path for improving health care delivery.”

If you are a health care professional, faculty member or student and are curious to know more, register to attend the Innovation in Health Care Delivery Systems Symposium on April 29-30 at the AT&T Executive Education & Conference Center.


#1 I am also a NP and I teach NP

I am also a NP and I teach NP students at a University. I plan on incorporating the use of EMR into my Health Assessment Course this Fall. I am also planning on looking at the use of EMR and diabetic outcomes and how it pertains to nurse practitioners. I would like to see if the use of EMR by NPs has a positive effect on the diabetic outcomes in certain populations. I wish more of the literature and research would look at other health care providers like NP and PA's . We are important players in the American health care system and I wish the research would focus on some of our practice patterns, speficifically the use of EMRs

#2 As a health care provider and

As a health care provider and clinical instructor for nursing students, I found this is a very timely topic and I am impressed with the insight of this article. In the future I would like to see research of this type include nurse practitioners and physician assistants with the physicians.

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