• Goetz GoldbergDeboraDDepartment of Health Policy, George Washington University, Center for Healthcare Quality, Washington, DC 20037, USA. goetzdc@gwu.edu, Anton J Kuzel, Lisa Bo Feng, Jonathan P DeShazo, and Linda E Love.
• Department of Health Policy, George Washington University, Center for Healthcare Quality, Washington, DC 20037, USA. goetzdc@gwu.edu
• Am J Manag Care. 2012 Feb 1; 18 (2): e48-54.

ObjectivesTo understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions.Study DesignQualitative case study of 6 primary care practices in Virginia.MethodsWe performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership.ResultsPhysicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrades and difficulty utilizing performance tracking and quality functions were also reported. Facilitators for adopting and using advanced EHR functions include team-based care, adequate technical support, communication and training for employees and physicians, alternative strategies for patient care during transition, and development of new processes and work flow procedures.ConclusionsSmall practices experience difficulty with implementation and utilization of advanced EHR functions. Federal and state policies should continue to support practices by providing technical assistance and financial incentives, grants, and/or loans. Small practices should consider using regional extension center services and reaching out to colleagues and other healthcare organizations with similar EHR systems for advice and guidance.

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