Difference between revisions of "Journal:Return on investment in electronic health records in primary care practices: A mixed-methods study"

From LIMSWiki
Jump to navigationJump to search
(Created stub. Going to add text later.)
 
(Added content. Saving and adding more.)
Line 42: Line 42:
The use of electronic health records (EHR) in clinical settings is widely recommended as an innovation enabler with potential benefits of reducing health care costs, while improving quality and safety, and is considered central to achieving patient-centered health care.<ref name="HillestadCan05">{{cite journal |title=Can electronic medical record systems transform health care? Potential health benefits, savings, and costs |journal=Heath Affairs |author=Hillestad, R.; Bigelow, J.; Bower, A.; Girosi, F.; Meili, R.; Scoville, R.; Taylor, R. |volume=24 |issue=5 |pages=1103-1117 |year=2005 |doi=10.1377/hlthaff.24.5.1103 |pmid=16162551}}</ref><ref name="BlumenthalStim09">{{cite journal |title=Stimulating the adoption of health information technology |journal=The New England Journal of Medicine |author=Blumenthal, D. |volume=360 |issue=15 |pages=1477-1479 |year=2009 |doi=10.1056/NEJMp0901592 |pmid=19321856}}</ref><ref name="BatesGet10">{{cite journal |title=Getting in step: electronic health records and their role in care coordination |journal=Journal of General Internal Medicine |author=Bates, D.W. |volume=25 |issue=3 |pages=174-176 |year=2010 |doi=10.1007/s11606-010-1252-x |pmid=20127195 |pmc=PMC2839327}}</ref><ref name="SaleemThe13">{{cite journal |title=The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs |journal=Journal of the American Medical Informatics Association |author=Saleem, J.J.; Flanagan, M.E.; Wilck, N.R.; Demetriades, J.; Doebbeling, B.N. |volume=20 |issue=e1 |pages=e175-e177 |year=2013 |doi=10.1136/amiajnl-2013-001748 |pmid=23599227 |pmc=PMC3715365}}</ref> As a wide array of EHR projects have been implemented within various health care settings, the health care field is rich with volumes of work examining the benefits of EHR. However, the existing literature reports mixed results in benefits realized from EHR implementation.<ref name="BlackThe11">{{cite journal |title=The impact of eHealth on the Quality and Safety of Health Care: a Systematic Overview |journal=PLoS Medicine |author=Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K. Bokun, T.; NcKinstry, B.; Procter, R.; Majeed, A.; Sheikh, A. |volume=8 |issue=1 |year=2013 |doi=10.1371/journal.pmed.1000387 |pmid=21267058 |pmc=PMC3022523}}</ref><ref name="HolroydThe11">{{cite journal |title=The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence |journal=Journal of the American Medical Informatics Association |author=Holroyd-Leduc, J.M.; Lorenzetti, D.; Straus, S.E.; Sykes, L.; Quan, H. |volume=18 |issue=6 |year=2011 |doi=10.1136/amiajnl-2010-000019 |pmid=21659445 |pmc=PMC3197985}}</ref> Such mixed results suggest that the implementation of EHR systems does not automatically guarantee the conversion of potential benefits into realized benefits.
The use of electronic health records (EHR) in clinical settings is widely recommended as an innovation enabler with potential benefits of reducing health care costs, while improving quality and safety, and is considered central to achieving patient-centered health care.<ref name="HillestadCan05">{{cite journal |title=Can electronic medical record systems transform health care? Potential health benefits, savings, and costs |journal=Heath Affairs |author=Hillestad, R.; Bigelow, J.; Bower, A.; Girosi, F.; Meili, R.; Scoville, R.; Taylor, R. |volume=24 |issue=5 |pages=1103-1117 |year=2005 |doi=10.1377/hlthaff.24.5.1103 |pmid=16162551}}</ref><ref name="BlumenthalStim09">{{cite journal |title=Stimulating the adoption of health information technology |journal=The New England Journal of Medicine |author=Blumenthal, D. |volume=360 |issue=15 |pages=1477-1479 |year=2009 |doi=10.1056/NEJMp0901592 |pmid=19321856}}</ref><ref name="BatesGet10">{{cite journal |title=Getting in step: electronic health records and their role in care coordination |journal=Journal of General Internal Medicine |author=Bates, D.W. |volume=25 |issue=3 |pages=174-176 |year=2010 |doi=10.1007/s11606-010-1252-x |pmid=20127195 |pmc=PMC2839327}}</ref><ref name="SaleemThe13">{{cite journal |title=The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs |journal=Journal of the American Medical Informatics Association |author=Saleem, J.J.; Flanagan, M.E.; Wilck, N.R.; Demetriades, J.; Doebbeling, B.N. |volume=20 |issue=e1 |pages=e175-e177 |year=2013 |doi=10.1136/amiajnl-2013-001748 |pmid=23599227 |pmc=PMC3715365}}</ref> As a wide array of EHR projects have been implemented within various health care settings, the health care field is rich with volumes of work examining the benefits of EHR. However, the existing literature reports mixed results in benefits realized from EHR implementation.<ref name="BlackThe11">{{cite journal |title=The impact of eHealth on the Quality and Safety of Health Care: a Systematic Overview |journal=PLoS Medicine |author=Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K. Bokun, T.; NcKinstry, B.; Procter, R.; Majeed, A.; Sheikh, A. |volume=8 |issue=1 |year=2013 |doi=10.1371/journal.pmed.1000387 |pmid=21267058 |pmc=PMC3022523}}</ref><ref name="HolroydThe11">{{cite journal |title=The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence |journal=Journal of the American Medical Informatics Association |author=Holroyd-Leduc, J.M.; Lorenzetti, D.; Straus, S.E.; Sykes, L.; Quan, H. |volume=18 |issue=6 |year=2011 |doi=10.1136/amiajnl-2010-000019 |pmid=21659445 |pmc=PMC3197985}}</ref> Such mixed results suggest that the implementation of EHR systems does not automatically guarantee the conversion of potential benefits into realized benefits.


The implementation of EHR systems within primary care practices is seen as particularly complex<ref name="GansMed05">{{cite journal |title=Medical groups' adoption of electronic health records and information systems |journal=Health Affairs |author=Gans, D.; Kralewski, J.; Hammons, T.; Dowd, B. |volume=24 |issue=5 |pages=1323-1333 |year=2005 |doi=10.1377/hlthaff.24.5.1323 |pmid=21659445 |pmc=PMC3197985}}</ref><ref name="DesRochesElec08">{{cite journal |title=Electronic health records in ambulatory care — a national survey of physicians |journal=The New England Journal of Medicine |author=DesRoches, C.M.; Campbell, E.G.; Rao, S.R.; Donelan, K.; Ferris, T.G.; Jha, A.; et al. |volume=359 |issue=1 |pages=50-60 |year=2008 |doi=10.1056/NEJMsa0802005 |pmid=18565855}}</ref><ref name="El-KarehTrends09">{{cite journal |title=Trends in primary care clinician perceptions of a new electronic health record |journal=Journal of General Internal Medicine |author=El-Kareh, R.; Gandhi, T.K.; Poon, E.G.; Newmark, L.P.; Ungar, J.; Lipsitz, S.; et al. |volume=24 |issue=4 |pages=464-468 |year=2009 |doi=10.1007/s11606-009-0906-z |pmid=19156468 |pmc=PMC2659149}}</ref><ref name="BassiPerc12">{{cite journal |title=Perceived impact of electronic medical records in physician office practices: a review of survey-based research |journal=Interactive Journal of Medical Research |author=Bassi, J.; Lau, F.; Lesperance, M. |volume=1 |issue=2 |pages=e3 |year=2012 |doi=10.2196/ijmr.2113 |pmid=23611832 |pmc=PMC3626136}}</ref>, with physicians and other staff in primary care practices citing obstacles such as difficulty in adapting to the significant changes in workflow and the time commitment required to learn to use the new software while prioritizing patient care [11-14]. While there is a growing body of evidence that EHR can be a valuable tool for improving quality of care and patient safety with relatively positive perceptions about EHR benefits [15-17], uncertainty about cost recovery of an EHR investment remains a significant concern in primary care practices [7,8,18,19]. Various studies on EHR impact and adoption also raise the need for cost-benefit analysis of EHR investments [5,20]. Thus, this study seeks to assess the return on investment (ROI) from an EHR implementation in primary care settings, aiming to complement the current insights on cost recovery concerns in existing literature.
The implementation of EHR systems within primary care practices is seen as particularly complex<ref name="GansMed05">{{cite journal |title=Medical groups' adoption of electronic health records and information systems |journal=Health Affairs |author=Gans, D.; Kralewski, J.; Hammons, T.; Dowd, B. |volume=24 |issue=5 |pages=1323-1333 |year=2005 |doi=10.1377/hlthaff.24.5.1323 |pmid=21659445 |pmc=PMC3197985}}</ref><ref name="DesRochesElec08">{{cite journal |title=Electronic health records in ambulatory care — a national survey of physicians |journal=The New England Journal of Medicine |author=DesRoches, C.M.; Campbell, E.G.; Rao, S.R.; Donelan, K.; Ferris, T.G.; Jha, A.; et al. |volume=359 |issue=1 |pages=50-60 |year=2008 |doi=10.1056/NEJMsa0802005 |pmid=18565855}}</ref><ref name="El-KarehTrends09">{{cite journal |title=Trends in primary care clinician perceptions of a new electronic health record |journal=Journal of General Internal Medicine |author=El-Kareh, R.; Gandhi, T.K.; Poon, E.G.; Newmark, L.P.; Ungar, J.; Lipsitz, S.; et al. |volume=24 |issue=4 |pages=464-468 |year=2009 |doi=10.1007/s11606-009-0906-z |pmid=19156468 |pmc=PMC2659149}}</ref><ref name="BassiPerc12">{{cite journal |title=Perceived impact of electronic medical records in physician office practices: a review of survey-based research |journal=Interactive Journal of Medical Research |author=Bassi, J.; Lau, F.; Lesperance, M. |volume=1 |issue=2 |pages=e3 |year=2012 |doi=10.2196/ijmr.2113 |pmid=23611832 |pmc=PMC3626136}}</ref>, with physicians and other staff in primary care practices citing obstacles such as difficulty in adapting to the significant changes in workflow and the time commitment required to learn to use the new software while prioritizing patient care.<ref name="KeshavjeeBest06">{{cite journal |url=http://www.infoclin.ca/assets/7e474_best%20practices%20in%20emr%20implementation%20-%20july,%202006.pdf |format=PDF |title=Best practices in EMR implementation: a systematic review |journal=AMIA Annual Symposium Proceedings |author=Keshavjee, K.; Bosomworth, J.; Copen, J.; Lai, J.; Kucukyazici, B.; Lilani, R.; et al. |volume=2006 |pages=982 |year=2006 |pmid=17238601 |pmc=PMC1839412}}</ref><ref name="IliePaper09">{{cite journal |title=Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies |journal=Decision Sciences |author=Ilie, V.; Van Slyke, C.; Parikh, M.A.; Courtney, J.F. |volume=40 |issue=2 |pages=213-241 |year=2009 |doi=10.1111/j.1540-5915.2009.00227.x}}</ref><ref name="ValdesInfo04">{{cite journal |url=http://www.ingentaconnect.com/content/bcs/ipc/2004/00000012/00000001/art00002 |title=Barriers to proliferation of electronic medical records |journal=Informatics in Primary Care |author=Valdes, I.; Kibbe, D.C.; Tolleson, G.; Kunik, M.E.; Petersen, L.A. |volume=12 |issue=1 |pages=3–9 |year=2004 |pmid=15140347}}</ref><ref name="ArcherAComp11">{{cite journal |title=A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices |journal=Journal of Medical Internet Research |author=Archer, N.; Cocosila, M. |volume=13 |issue=3 |pages=e57 |year=2011 |doi=10.2196/jmir.1726 |pmid=21840835 |pmc=PMC3222163}}</ref> While there is a growing body of evidence that EHR can be a valuable tool for improving quality of care and patient safety with relatively positive perceptions about EHR benefits<ref name="TerryImp08">{{cite journal |title=Implementing electronic health records: Key factors in primary care |journal=Canadian Family Physician |author=Terry, A.L.; Thorpe, C.F.; Giles, G.; Brown, J.B.; Harris, S.B.; Reid, G.J.; Thind, A.; Stewart, M. |volume=54 |issue=5 |pages=730-736 |year=2008 |pmid=18474707 |pmc=PMC2377228}}</ref><ref name="LudwickAdopt09">{{cite journal |title=Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries |journal=International Journal of Medical Informatics |author=Ludwick, D.A.; Doucette, J. |volume=78 |issue=1 |pages=22-31 |year=2009 |doi=10.1016/j.ijmedinf.2008.06.005 |pmid=18644745}}</ref><ref name="BoonstraBar10">{{cite journal |title=Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions |journal=BMC Health Services Research |author=Boonstra, A.; Broekhuis, M. |volume=10 |pages=231 |year=2010 |doi=10.1186/1472-6963-10-231 |pmid=20691097 |pmc=PMC2924334}}</ref>, uncertainty about cost recovery of an EHR investment remains a significant concern in primary care practices.<ref name="GansMed05" /><ref name="DesRochesElec08" /><ref name="SimonCorr07">{{cite journal |title=Correlates of electronic health record adoption in office practices: a statewide survey |journal=Journal of the American Medical Informatics Association |author=Simon, S.R.; Kaushal, R.; Cleary, P.D.; Jenter, C.A.; Volk, L.A.; Poon, E.G.; et al. |volume=14 |pages=110-117 |year=2007 |pmid=17068351 |pmc=PMC2215070}}</ref><ref name="KemperAdop06">{{cite journal |title=Adoption of electronic health records in primary care pediatric practices |journal=Pediatrics |author=Kemper, A.R.; Uren, R.L.; Clark, S.J. |volume=118 |issue=1 |pages=e20-4 |year=2006 |pmid=16818534}}</ref> Various studies on EHR impact and adoption also raise the need for cost-benefit analysis of EHR investments.<ref name="BlackThe11" /><ref name="RozenblumAQual11">{{cite journal |title=A qualitative study of Canada’s experience with the implementation of electronic health information technology |journal=CMAJ |author=Rozenblum, R.; Jang, Y.; Zimlichman, E.; Zalzberg, C.; Tamblyn, M.; Buckeridge, D.; et al. |volume=183 |issue=5 |pages=e281-8 |year=2011 |doi=10.1503/cmaj.100856 |pmid=21343262 |pmc=PMC3060213}}</ref> Thus, this study seeks to assess the return on investment (ROI) from an EHR implementation in primary care settings, aiming to complement the current insights on cost recovery concerns in existing literature.


==References==
==References==
Line 48: Line 48:


==Notes==
==Notes==
This presentation is faithful to the original, with only a few minor changes to presentation. The PubMed ID has been added when missing to make the references more useful.
This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the PubMed ID was missing and was added to make the reference more useful.


Per the distribution agreement, the following copyright information is also being added:  
Per the distribution agreement, the following copyright information is also being added:  

Revision as of 18:43, 4 August 2015

Full article title Return on investment in electronic health records in primary care practices: A mixed-methods study
Journal JMIR Medical Informatics
Author(s) Jang, Yeona; Lortie, Michel A.; Sanche, Steven
Author affiliation(s) McGill University, Desautels Faculty of Management; St Mary's Research Centre, Montreal
Primary contact Email: yeona.jang@mcgill.ca; Phone: 1.514.398.8489
Year published 2014
Volume and issue 2 (2)
Page(s) e25
DOI 10.2196/medinform.3631
ISSN 2291-9694
Distribution license Creative Commons Attribution 2.0
Website http://medinform.jmir.org/2014/2/e25/
This article should not be considered complete until this message box has been removed. This is a work in progress.

Abstract

Background: The use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices.

Objective: Guided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment.

Methods: Given the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems.

Results: We collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months.

Conclusions: We found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices.

Keywords: return on investment in electronic health records; cost recovery from EHR implementation; ROI indicator; physician satisfaction with EHR; primary care practices

Introduction

Context

The use of electronic health records (EHR) in clinical settings is widely recommended as an innovation enabler with potential benefits of reducing health care costs, while improving quality and safety, and is considered central to achieving patient-centered health care.[1][2][3][4] As a wide array of EHR projects have been implemented within various health care settings, the health care field is rich with volumes of work examining the benefits of EHR. However, the existing literature reports mixed results in benefits realized from EHR implementation.[5][6] Such mixed results suggest that the implementation of EHR systems does not automatically guarantee the conversion of potential benefits into realized benefits.

The implementation of EHR systems within primary care practices is seen as particularly complex[7][8][9][10], with physicians and other staff in primary care practices citing obstacles such as difficulty in adapting to the significant changes in workflow and the time commitment required to learn to use the new software while prioritizing patient care.[11][12][13][14] While there is a growing body of evidence that EHR can be a valuable tool for improving quality of care and patient safety with relatively positive perceptions about EHR benefits[15][16][17], uncertainty about cost recovery of an EHR investment remains a significant concern in primary care practices.[7][8][18][19] Various studies on EHR impact and adoption also raise the need for cost-benefit analysis of EHR investments.[5][20] Thus, this study seeks to assess the return on investment (ROI) from an EHR implementation in primary care settings, aiming to complement the current insights on cost recovery concerns in existing literature.

References

  1. ↑ Hillestad, R.; Bigelow, J.; Bower, A.; Girosi, F.; Meili, R.; Scoville, R.; Taylor, R. (2005). "Can electronic medical record systems transform health care? Potential health benefits, savings, and costs". Heath Affairs 24 (5): 1103-1117. doi:10.1377/hlthaff.24.5.1103. PMID 16162551. 
  2. ↑ Blumenthal, D. (2009). "Stimulating the adoption of health information technology". The New England Journal of Medicine 360 (15): 1477-1479. doi:10.1056/NEJMp0901592. PMID 19321856. 
  3. ↑ Bates, D.W. (2010). "Getting in step: electronic health records and their role in care coordination". Journal of General Internal Medicine 25 (3): 174-176. doi:10.1007/s11606-010-1252-x. PMC PMC2839327. PMID 20127195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839327. 
  4. ↑ Saleem, J.J.; Flanagan, M.E.; Wilck, N.R.; Demetriades, J.; Doebbeling, B.N. (2013). "The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs". Journal of the American Medical Informatics Association 20 (e1): e175-e177. doi:10.1136/amiajnl-2013-001748. PMC PMC3715365. PMID 23599227. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715365. 
  5. ↑ 5.0 5.1 Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K. Bokun, T.; NcKinstry, B.; Procter, R.; Majeed, A.; Sheikh, A. (2013). "The impact of eHealth on the Quality and Safety of Health Care: a Systematic Overview". PLoS Medicine 8 (1). doi:10.1371/journal.pmed.1000387. PMC PMC3022523. PMID 21267058. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022523. 
  6. ↑ Holroyd-Leduc, J.M.; Lorenzetti, D.; Straus, S.E.; Sykes, L.; Quan, H. (2011). "The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence". Journal of the American Medical Informatics Association 18 (6). doi:10.1136/amiajnl-2010-000019. PMC PMC3197985. PMID 21659445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197985. 
  7. ↑ 7.0 7.1 Gans, D.; Kralewski, J.; Hammons, T.; Dowd, B. (2005). "Medical groups' adoption of electronic health records and information systems". Health Affairs 24 (5): 1323-1333. doi:10.1377/hlthaff.24.5.1323. PMC PMC3197985. PMID 21659445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197985. 
  8. ↑ 8.0 8.1 DesRoches, C.M.; Campbell, E.G.; Rao, S.R.; Donelan, K.; Ferris, T.G.; Jha, A.; et al. (2008). "Electronic health records in ambulatory care — a national survey of physicians". The New England Journal of Medicine 359 (1): 50-60. doi:10.1056/NEJMsa0802005. PMID 18565855. 
  9. ↑ El-Kareh, R.; Gandhi, T.K.; Poon, E.G.; Newmark, L.P.; Ungar, J.; Lipsitz, S.; et al. (2009). "Trends in primary care clinician perceptions of a new electronic health record". Journal of General Internal Medicine 24 (4): 464-468. doi:10.1007/s11606-009-0906-z. PMC PMC2659149. PMID 19156468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659149. 
  10. ↑ Bassi, J.; Lau, F.; Lesperance, M. (2012). "Perceived impact of electronic medical records in physician office practices: a review of survey-based research". Interactive Journal of Medical Research 1 (2): e3. doi:10.2196/ijmr.2113. PMC PMC3626136. PMID 23611832. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626136. 
  11. ↑ Keshavjee, K.; Bosomworth, J.; Copen, J.; Lai, J.; Kucukyazici, B.; Lilani, R.; et al. (2006). "Best practices in EMR implementation: a systematic review" (PDF). AMIA Annual Symposium Proceedings 2006: 982. PMC PMC1839412. PMID 17238601. http://www.infoclin.ca/assets/7e474_best%20practices%20in%20emr%20implementation%20-%20july,%202006.pdf. 
  12. ↑ Ilie, V.; Van Slyke, C.; Parikh, M.A.; Courtney, J.F. (2009). "Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies". Decision Sciences 40 (2): 213-241. doi:10.1111/j.1540-5915.2009.00227.x. 
  13. ↑ Valdes, I.; Kibbe, D.C.; Tolleson, G.; Kunik, M.E.; Petersen, L.A. (2004). "Barriers to proliferation of electronic medical records". Informatics in Primary Care 12 (1): 3–9. PMID 15140347. http://www.ingentaconnect.com/content/bcs/ipc/2004/00000012/00000001/art00002. 
  14. ↑ Archer, N.; Cocosila, M. (2011). "A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices". Journal of Medical Internet Research 13 (3): e57. doi:10.2196/jmir.1726. PMC PMC3222163. PMID 21840835. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222163. 
  15. ↑ Terry, A.L.; Thorpe, C.F.; Giles, G.; Brown, J.B.; Harris, S.B.; Reid, G.J.; Thind, A.; Stewart, M. (2008). "Implementing electronic health records: Key factors in primary care". Canadian Family Physician 54 (5): 730-736. PMC PMC2377228. PMID 18474707. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377228. 
  16. ↑ Ludwick, D.A.; Doucette, J. (2009). "Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries". International Journal of Medical Informatics 78 (1): 22-31. doi:10.1016/j.ijmedinf.2008.06.005. PMID 18644745. 
  17. ↑ Boonstra, A.; Broekhuis, M. (2010). "Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions". BMC Health Services Research 10: 231. doi:10.1186/1472-6963-10-231. PMC PMC2924334. PMID 20691097. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334. 
  18. ↑ Simon, S.R.; Kaushal, R.; Cleary, P.D.; Jenter, C.A.; Volk, L.A.; Poon, E.G.; et al. (2007). "Correlates of electronic health record adoption in office practices: a statewide survey". Journal of the American Medical Informatics Association 14: 110-117. PMC PMC2215070. PMID 17068351. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2215070. 
  19. ↑ Kemper, A.R.; Uren, R.L.; Clark, S.J. (2006). "Adoption of electronic health records in primary care pediatric practices". Pediatrics 118 (1): e20-4. PMID 16818534. 
  20. ↑ Rozenblum, R.; Jang, Y.; Zimlichman, E.; Zalzberg, C.; Tamblyn, M.; Buckeridge, D.; et al. (2011). "A qualitative study of Canada’s experience with the implementation of electronic health information technology". CMAJ 183 (5): e281-8. doi:10.1503/cmaj.100856. PMC PMC3060213. PMID 21343262. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060213. 

Notes

This presentation is faithful to the original, with only a few minor changes to presentation. In several cases the PubMed ID was missing and was added to make the reference more useful.

Per the distribution agreement, the following copyright information is also being added:

©Yeona Jang, Michel A Lortie, Steven Sanche. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 29.09.2014.

Retrieved from "https://www.limswiki.org/index.php?title=Journal:Return_on_investment_in_electronic_health_records_in_primary_care_practices:_A_mixed-methods_study&oldid=22145"