Use and satisfaction with electronic health record by primary care physicians in a health district in Brazil

It is believed that Electronic Health Records (EHR) improve not only quality of care but also patient safety and health care savings. This seems to be true for developed countries but not necessarily in emerging economies. This paper examined the primary care physicians' satisfaction with a specific EHR in a health district of a major city in Brazil and describes how they are using it as well as its specific functions. A cross-sectional questionnaire survey with all physicians from all Community Health Centers of the 6th health district of the City of Fortaleza that were using HER was conducted. From the 111 subjects (100%), a total of 99 physicians answered the survey (89% response rate). For overall satisfaction with the EHR, 2 (2%) were satisfied, 50 (50.5%) were satisfied in part and 47 (47.5%) were not satisfied. For the functionalities, a proportion of correct answers (PCA) and an index of functionality usage (IFU) were developed. PCA and IFU were significantly correlated (p < 0.001). Inverse and weak correlations were found between PCA and age (p < 0.001), years since medical school and years of work (p < 0.01). For usage (IFU), there was inverse correlation with "years working in Family Health Strategy" (p < 0.05). High IFU was associated with physicians who stated to use easily Internet and Email; who saw less patients per half-day; who were women (p < 0.05), younger (p < 0.05), in training (p < 0.05) and not satisfied with the EHR (p < 0.05).The use of EHR was associated with being young, female, still in training and seeing less than 16 patients per half-day. Structural issues (e.g. network and system support) seemed to be major barriers in this setting. Lack of classical functionalities such as problem list and clinical reminders could have contributed to exacerbate misperceptions about what EHRs can do in improving work processes and patient care.