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Late adopters of the electronic health record should move now
  1. Juliet Rumball-Smith1,
  2. Kevin Ross1,
  3. David W Bates2,3
  1. 1 Precision Driven Health, Auckland, New Zealand
  2. 2 Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
  3. 3 Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, United States
  1. Correspondence to Dr Juliet Rumball-Smith, c/o: Precision Driven Health, 181 Grafton Road, Auckland, 1010, New Zealand; jrs{at}

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Internationally, the last decade has seen the rapid adoption of electronic health records (EHRs) in hospitals and ambulatory care; EHRs are now an accepted enabler of a high-performing health system.1 However, the uptake and extent of use of this technology varies substantially. At the country level, Estonia and Sweden are among those nations with mature, interoperable EHRs with high patient access.2 3 In contrast, Switzerland and the UK have only patchy adoption in secondary care,4 5 and New Zealand, an early exemplar of primary care digitisation,6 has not yet integrated this information nationally, nor that of hospitals, at scale. Within countries also, there is variation. Even in jurisdictions with high overall rates of adoption, some providers are sophisticated ‘super-users’ of EHRs, whereas others use only their rudimentary functionalities.7–9

The adoption and full employment of an EHR reflects multiple factors, not the least of which are the financial and non-financial costs of procuring and implementing these platforms.10 Federal-level investment—including policy development, use of legislative levers, and support with resources or subsidies—undoubtedly affects the speed of adoption.11 However, even within a maximally supportive environment, there are those who remain ‘EHR-wary’, citing both uncertain benefit and risk of harm (particularly to clinicians). In this viewpoint, we argue that these EHR concerns may be overstated, irrelevant and/or mitigable, and should neither be used to justify delays in adoption nor full use. We maintain that late adopters and ‘under-users’—be they countries, hospitals or individual clinicians—should embrace this technology, and would benefit from prioritising its adoption and comprehensive use.

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