Suggestions for overcoming barriers in the adoption of electronic health record systems in California's Central Valley: A qualitative analysis

Healthcare providers in the San Joaquin Valley in central California has been reluctant to adopt electronic health record (EHR) system despite its potential to eliminate disparities in healthcare access and provision, a major challenge in this rural region. There is a lack of understanding regarding the reasons behind this phenomenon.

The objective of this study was to understand the barriers - financial, technological, regulatory, reimbursement and others - in EHR adoption by the healthcare providers in this rural area and to suggest possible ways in which it can improve healthcare for the underserved.

A qualitative iterative strategy was undertaken to analyze data obtained through in-depth interviews of healthcare managers and practitioners. In total, 7 health care organizations in this rural region were identified and 12 administrators and 8 physicians were interviewed. The interview transcripts and field notes were read to extract common impression and preliminary categorizations. After the interview contents were classified in respect to those categories, the emerging patterns and themes were identified. Finally, the analyses were compared and adjusted after a thorough final review.

Several factors were identified as major barriers to adoption of EHR systems. It was found that uncertainty about its benefits and potential financial returns as opposed to higher upfront investment and lack of clarity of existing regulations, act as major disincentives to rural providers. Another barrier pertinent to the region is the unique contractual arrangement among part-time specialist physicians and the management, which make it harder for the administrators to implement EHR projects.

Several non-traditional methods have been suggested to enhance EHR acceptance among health service providers so that it improves access to the rural and the underprivileged patients. Lessons can be drawn from this research to understand ways in which adoption of EHR systems can be enhanced in other rural areas.