A Qualitative Multiple-case Study of Electronic Health Record Adoption in Office-based Physician Practices

A Qualitative Multiple-case Study of Electronic Health Record Adoption in Office-based Physician Practices

Author: 
Stephen L. Meigs
Program of study: 
D.H.A.
Abstract: 
The purpose of this qualitative multiple-case study was to explore why primary care physicians in office-based practices have been slow to adopt EHR systems. Semistructured interviews were conducted with 16 office-based physicians in San Antonio, Texas. Participants also completed a concise demographics and technology use survey. Analysis of data from interviews and surveys was an iterative process consisting of examination, coding, categorization, pattern and theme identification, and cross-case synthesis. Important findings included physicians’ perceptions that organizational support programs provided through the HITECH Act were having a mixed impact on the adoption of EHRs; the belief among physicians that EHRs create both efficiencies and inefficiencies in healthcare delivery; physician perceptions that lack of interoperability among EHRs is a major barrier to meaningful use of the systems; and physician belief that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among officebased physician practices have produced positive results, additional support may be required to maintain this momentum. Recommendations for encouraging continued adoption of EHRs in office-based physician practices include improving organizational support to office-based physician practices, incorporating EHR certification requirements that address user-interface and usability, and continuing to educate the public on the potential value of EHR use in the delivery and quality of healthcare. The results of this study may assist policy makers in developing strategies and policies that facilitate successful adoption and use of EHRs in office-based settings.
Dedication: 
I dedicate this dissertation to my wife Maggie for her unfailing love, patience, and encouragement during my doctoral journey. Simply put, I would not have taken or completed this journey without her love and collaboration. I love you and am so grateful for you.
Acknowledgements: 
First and foremost, I would like to express my sincere gratitude to my dissertation committee members: Dr. Michael Solomon, Dr. Eve Kaczmarek, and Dr. Gerald Olivas. These exceptional scholars and mentors demonstrated seemingly unending patience and support in guiding me toward completion of this goal. Special thanks to Dr. Solomon, who served as both a committee member and later as my Chair. I will always be especially grateful for his willingness to take the reins late in the game and to guide me through the final stages of the process. His insights as a scholar and domain expert contributed significantly to my research. Dr. Kaczmarek’s influence traces back to my year-one residency in this program. As such, she has been encouraging me from the very beginning of this process and I am most thankful for her friendship and mentoring. Likewise, I am extremely grateful to Dr. Olivas for his willingness to join my committee toward the end of the process—his insights and contributions to my research were enormous. Dr. Jeanmarie Pinto provided extraordinary support toward the end of this journey as my editor and APA expert. I am extremely grateful to her for both her expertise and encouragement. My wife Maggie also deserves special recognition here for her many, many hours of reviewing and editing my work over the past 3 years. Additionally, she patiently spent countless hours listening and brainstorming with me as I made my way along this journey. I simply could not have done this without her. Finally, I need to acknowledge all the physicians who graciously contributed their valuable time and insights to assist me with this study. Despite their extremely busy schedules, each gave freely of their time in the cause of advancing knowledge. Interviewing these compassionate, dedicated healthcare professionals was a privilege. Truly, without their participation, this research would not have been possible.