If electronic medical records are so great, why aren't family physicians using them?

OBJECTIVE: The chasm theory of marketing states that fundamental differences exist between early adopters of technology and the mainstream marketplace, making it difficult for technology to transition to the mainstream market. We investigated possible differences in attitudes and beliefs about electronic medical records (EMRs) between current EMR users (early market) and nonusers (mainstream market). STUDY DESIGN: Cross-sectional mail survey. POPULATION: Active members in the Indiana Academy of Family Physicians 2000-2001 membership database (N = 1328). OUTCOMES MEASURED: Differences in attitudes, beliefs, and demographic characteristics of EMR users and nonusers. RESULTS: The overall return rate was 51.7%; 14.4% of respondents currently use an EMR. Electronic medical record users were more likely to practice in urban areas or to be hospital-based and reported seeing fewer patients. Nonusers were less likely to believe that (1) physicians should computerize their medical records; (2) current EMRs are a useful tool for physicians; (3) EMRs improve quality of medical records and decrease errors; and (4) it is easy to enter data into current EMRs. Nonusers were more likely to believe that paper records are more secure and more confidential than EMRs. Both users and nonusers believed that current EMRs are too expensive. CONCLUSIONS: A chasm exists between EMR users and nonusers regarding issues that affect EMR implementation, including necessity, usefulness, data entry, cost, security and confidentiality. To reach full implementation of EMRs in family medicine, organizations should use these data to target their research, education, and marketing efforts.

An analysis of patient compliance with nurse recommendations from an after-hours call center.

OBJECTIVES: To demographically and clinically describe the callers who use an after-hours call center (AHCC); to estimate the level of patient satisfaction with the AHCC; to determine caller compliance with the AHCC nurse's recommendation; and to examine the relationship between compliance and selected demographic and clinical characteristics, including caller satisfaction. STUDY DESIGN: A prospective, quasi-experimental telephone survey. PATIENTS AND METHODS: Randomly selected callers (n = 427) to an AHCC were surveyed by telephone to determine their satisfaction with the services provided and their compliance with the AHCC nurse's recommendation. RESULTS: Overall, 88.2% of the AHCC clients were compliant with the nurse's recommendations. Logistic regression analysis revealed that 2 patient variables had a statistically significant impact on compliance. Patients or their surrogates (eg, parents/guardians, caregivers) who were "very satisfied" were more than 4 times more likely to be compliant, and the surrogates of the patients under the age of 1 year were more than 20 times more likely to be compliant. The greatest level of patient dissatisfaction was with the time it took to make contact with the nurse. Decreasing this response time may improve satisfaction, which in turn may increase compliance and lead to more desirable health outcomes. CONCLUSIONS: The level of compliance was found to be favorable for all levels of acuity. However, the results indicate a further need for quality improvement activities.