Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless

Objective: The purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al.(1) The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption. Design: Meta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a "Universal EHR Adoption" by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices. Measurement: EHR adoption parameters-external and internal coefficients of influence-are estimated using bass diffusion models and future adoption rates are projected. Results: Comparing the EHR adoption rates before and after 2004 (2001-2004 and 2001-2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on Current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%). Conclusions: The external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion. J Am Med Inform Assoc. 2009;16:274-281. DOI 10.1197/jamia.M3042.