Strategies for development and adoption of EHR in German ambulatory care

Electronic Health Records (EHR) have the potential to improve the delivery of health care. In Germany most physicians in ambulatory care have adopted Electronic Medical Records (EMR) locally within their institutions, using their practice information systems. A national telematics initiative, which connects various local medical information systems via a common infrastructure, aims to achieve integrated care, supported by comprehensive, citizen controlled medical documentation. This requires the adoption of connected EHR which leads to several technical, organizational, and psychological barriers. In early 2009, we conducted a survey of 117 physicians, representing a response rate of 23%, to investigate requirements for national EHR initiatives. We evaluated the preferred content of EHR, diffusion methods favored by care providers, and the desired level of patient involvement. Results indicate that private companies and government related organizations show little support among the physicians; the preferred institutions for hosting and offering electronic health services (EHS) as EHR are medical associations and physician networks. They are also the preferred source for information concerning EMS. Medication, allergies and intolerances are reported to be of capital importance for physicians, while shared documentation of diagnosis and examination results raise the highest rate of skepticism. It is mainly the patient centered administration of EHR that is wanted, albeit still with skepticism.