Information technologies: when will they make it into physicians' black bags?

Physicians in the United States are only slowly adopting information technology (IT) tools, despite studies demonstrating their clinical benefits. More is known about IT use within institutional settings than by individual physicians.

This study investigates physicians' current use of, future plans for, and perceived barriers to adopting electronic medical records (EMRs), computerized prescribing and order entry, clinical decision support systems, and electronic communication (email) with other physicians and with patients.

Self-administered mail surveys were completed between March and May 2003 among a national random sample of physicians involved in direct patient care of adults. A total of 1837 surveys were returned for a response rate of 52.8%.

Physicians most commonly use IT for billing. For clinical management, the most common tool is computerized access to laboratory results (59%). Other tools are less prevalent: Twenty-seven percent of respondents use EMRs routinely or occasionally; 27% prescribe or order tests electronically; and 12% receive electronic alerts about potential drug-prescribing problems. Only 24% of surveyed physicians practice in a "high-tech" office setting. Physicians in groups of 50 or more are significantly more likely to use any IT tools and to practice in a high-tech office, as compared with physicians in solo practice (odds ratio = 7.7). The top 3 barriers to adoption of IT are start-up costs (56%), lack of uniform standards (44%), and lack of time (39%).

Most physicians do not use EMRs and related technologies. Adoption is uneven, and a technologic divide exists between physicians depending on their practice environment and mode of compensation. Cost remains the most important barrier to adoption. Attention needs to be focused on policies and business models that will make IT tools accessible and affordable to all physicians.