Impact of Perceived Barriers of Electronic Health Information Exchange on Physician's Use of EHR: A Normalisation Process Theory Approach

Digitizing healthcare is a major aim of healthcare policy, with efforts aimed at increasing adoption of electronic health records (EHRs). We study the capability use for EHRs through the lens of normalisation process theory to assess whether these barriers to adoption also remain barriers to sustained use. We focus on health information exchange (HIE), which is one of the most challenging capabilities identified in the literature. We analyse the National Electronic Health Records Survey data, in which physicians were asked whether known HIE adoption barriers remain in place, and how frequently they use HIE capabilities. Though we expect that adoption barriers reported to be less problematic will be associated with greater capability use, we found that adoption barriers perceived to be more (less) problematic were not necessarily those that predicted less (greater) capability use. This study contributes through a critical examination of the process of normalization of EHR capabilities.