What factors affect the use of electronic patient records by Irish GPs?

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Abstract

Background

The use of electronic patient records (EPR) by Irish GPs has grown substantially over the past decade but a significant number of GPs continue to use manual record systems.

Objectives

This study attempts to determine the factors which affect the uptake of an EPR by Irish GPs.

Methods and materials

Two national postal surveys of Irish General Practitioners (GPs) were carried out in 2000 and again in 2003. Response rates were 69% (n = 1543) and 60% (n = 1408), respectively.

Results

The data collected reveal that electronic patient records are in widespread use among Irish general practitioners. Furthermore the study shows that the use of electronic patient records for common clinical and administrative tasks is increasing.

Comparative analysis of the data revealed statistically significant differences between subgroups of responders. GPs were more likely to use an EPR for clinical tasks if they were young and male. GPs in group practice and GPs with mostly state-funded patient lists were more likely to use an EPR as were GPs in rural locations. Much higher use of an EPR for clinical tasks was found among GPs who were involved in the training of newly qualified GPs.

The most significant perceived barrier preventing GPs migrating from manual to electronic records was “lack of time”. While lack of financial resources and absence of computer skills were also perceived as barriers, these were found to be less significant.

Discussion

While the increasing use of an EPR among younger GPs was expected, the lower usage among female GPs and those in urban locations was not and has not been previously reported. The data has important implications for the planned roll out of electronic patient records as outlined in Ireland's National Health Information Strategy.

Introduction

The Republic of Ireland has produced three strategy documents which map out the future development of our health services [1], [2], [3]. Each of these lists the development of an electronic patient record (EPR) that can be shared across all sectors of the health service as a key objective. One of the key contributors to the EPR will be the country's 2600 GPs who manage the vast majority of its population's health problems. The adoption of the EPR by Irish GPs has been slow relative to some of our European neighbours [4]. This paper attempts to determine the reasons behind this slow uptake and examine the individual factors which influence the use of an EPR by GPs in the Republic of Ireland.

The study is based on two national surveys of EPR use by Irish GPs and analyses the extent to which they are in use, the factors affecting their use and the perceived barriers to their use among GPs in the Republic of Ireland. All practice management software products used by GPs in Ireland go through a mandatory certification process, overseen by the General Practitioner Information Technology (GPIT) group. This organisation is funded by the state and the group ensures that all available software products conform to minimum functional standards. The software functions assessed in this study are present in all of the available GP practice management software products.

GPs in Ireland are the principal providers of primary care services to its population of 4 million people. Approximately 30% of the population hold “medical cards” which entitle them to free visits to their GP as well as free drugs. GPs receive a payment from the state in respect of the care of this group of patients. The other 70% of the population pay the GP a fee for services received. Approximately 84% of all GPs in the Republic of Ireland participate in the state-funded medical card scheme [5].

Section snippets

Methods

The mode of data collection was two postal questionnaire to all GPs residing in the Republic of Ireland and registered on the Irish College of General Practitioners (ICGP) database. In the first survey, 2226 GPs were sent questionnaires while in the second 2362 GPs were surveyed. As over 85% of all GPs practicing in Ireland are members of the ICGP it was considered that this group would accurately reflect the national picture. Non-ICGP members were not surveyed as it is difficult to establish

Response to questionnaire

Table 1 illustrates the response rates for the two surveys. 1629 out of 2226 (73.1%) completed responses were returned in the first survey while the second yielded a slightly lower return of 1452 out of 2362 (61.4%). After removal of GPs who were not actively working in General Practice, the valid response was 1543 (69%) for the March 2000 survey and 1408 (60%) for the second survey in 2003.

Demographics of respondents

Table 1 also shows the gender breakdown of respondents in the two surveys. It reveals that in 2003,

Discussion

The study suggests that the use of electronic patient records by Irish GPs is increasing and GPs are using their EPR for clinical as well as administrative tasks. The commonest use of an EPR in the study was patient registration followed closely by repeat prescribing.

Our methodology was to use two questionnaires sent out to all GPs on our database over an interval of 3 years. While this approach is simple and practical, more qualitative information may have been gathered by interviewing a

Conclusions

Our results suggest there was a significant increase in the use of EPR by Irish GPs over a 3-year interval between our two surveys. Some differences were noted between subgroups of GPs. GPs most likely to use an EPR were young, male, and working in group practices. They were also more likely to be based in a rural location and be involved in GP vocational training.

Those not using an EPR during the study period rated lack of time, cost and an absence of computer skills as important barriers

Acknowledgements

Funding for this study came from the National GPIT group. Our thanks to Mr. Peter Lennon, former National Director of the GPIT group and all of the GPs who completed and returned our questionnaire.

Contributions. All three authors were involved in the conception and design of the study, the acquisition and analysis of data, and interpretation of data. Drafting of the article for publication was carried out by Dr. Brian Meade but approval of the final version was sought and given by the other

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