My experience with paper and electronic patient records is opposite that of many physicians in practice today. The medical school I attended was an early adopter of EHRs, and that’s how I was trained to access patient records. But when I entered practice, my work environment still was heavily into paper.

For all of their deficiencies, I preferred some aspects of paper charts early in my career. Over decades of use, the formats of paper charts were honed for optimal efficiency. For instance, when I made rounds at the hospital, the paper chart had a section on orders that I could flip to and immediately see what had been ordered and when and by whom. I was able to get a quick snapshot of what had been happening with my patients since the last time I visited.

I needed the digital record to be as informative and efficient to support my workday. My subsequent transition to EHRs was easier for me than most because of my digital background. Now I’m a true believer in the power of EHRs to improve patient care. However, I know that there still are many opportunities to improve them.

I thought about that experience when I read a report from the HHS Office of the National Coordinator for Health Information Technology on what motivates doctors to adopt—and not adopt—EHRs (PDF, 1.8 MB). The ONC report said the primary motivation for adopting EHRs was incentive payments or financial penalties from the government. It said the primary motivation for not adopting EHRs was lack of resources. In both cases, the top motivating factor was financial, not patient- or quality-related.

Money has been a powerful motivator. The latest data from the National Center for Health Statistics peg the percentage of office-based physicians using any type of EHR system in 2013 at 78.4 percent, with 48.1 percent using a basic EHR system. Those numbers are up substantially from 2008, or a year before the HITECH Act was passed, when they were 42 percent and 16.9 percent, respectively.

So the question is, what can we do as an industry to convince the remaining 20 percent of physicians—the EHR holdouts—to go electronic? I would suggest the following two strategies.

  • First, we need to reconfigure EHR systems to make it easier for physicians to get the information they need from a patient’s medical record so they can provide the best possible care. That may mean making a patient’s EHR searchable. It also may mean adding advanced analytical capabilities that would synthesize information in the EHR to assist doctors with clinical decision-making. It’s about helping physicians find patient information and helping them decide how to use that patient information.

  • Second, we need to reconfigure EHR systems to address physicians’ concerns about loss of productivity. Doctors want to spend less time on data entry and more time seeing patients. A number of initiatives are underway that will make data entry easier, such as adding voice recognition capabilities and natural language processing to EHR systems. Addressing the productivity issue will be a significant factor in improving both adoption and satisfaction with EHRs for physicians.

[Editor’s note: To learn more about how to make EHRs systems attractive to physicians, read “Optimizing Quality Measurement and Reporting with IT Systems” on]

Outside stakeholders can play a role in converting EHR holdouts. The two biggest are payers and patients. Payers can promote, via reimbursement mechanisms, the value of electronically aggregating patient data across the continuum of care and care settings to produce a rich source of information that physicians can tap to improve the effectiveness of care. Patients want to be engaged with their care and caregivers, and they increasingly will expect the ability to share information electronically with their doctors.

Will we ever see 100 percent adoption of EHRs by physicians? We will get there eventually as older physicians retire and are replaced by younger doctors who know nothing other than EHRs. We can get there sooner if we optimize EHR systems to make it easier for doctors to input and extract actionable patient information, and a little nudge from payers and patients will also help.