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Inform Prim Care. 2004;12(1):3-9.

Barriers to proliferation of electronic medical records.

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Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Department of Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA.



Error reduction, quality improvement and lowering of cost can all be achieved through electronic integration of healthcare providers. Proliferation of standard electronic health records/ electronic medical records (EHR/EMR) software is an essential precursor of this integration. Proliferation of EHR/EMR software has not occurred in the United States.


To characterise users and non-users of EHR/EMR software, identify potential barriers to proliferation, examine the extent of standardisation across reported EHR/EMR and suggest possible solutions to identified barriers.


We performed a secondary analysis of member survey data collected by the American Academy of Family Physicians (AAFP) in January 2003. The purpose of the survey was to measure interest in an AAFP-sponsored EHR/EMR service. We examined demographic and purchasing data from the survey by gender, population density, region and age. We also counted the number of different software vendors reported by users of an EHR/EMR to assess the number of users with unique software.


Of the 35,554 members contacted, 5517 (15.5%) responded. Of those responding, 1297 (23.5%) reported use of an EHR/EMR. Of the members responding, 81% reported interest in EHR/EMR software and 61% reported cost as a major reason for not purchasing it. At least 264 different EHR/ EMR software programs are currently in use. On average, the percentage of respondents with the same EHR/EMR software is 0.4%.


The number of AAFP members with unique EHR/EMR software is very large. Fragmentation, caused by the use of hundreds of unique systems, is a major barrier to proliferation of these systems. Many of the barriers to proliferation could be mitigated through the tools and techniques available through Free and Open Source Software (FOSS).

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