Physicians and ambulatory electronic health records.

Few U.S. physicians use outpatient electronic health records (EHRs), although it appears that most would like to begin. The main barriers are not technical, because adoption rates in other countries are high. The biggest barrier is reimbursement, because physicians must pay for EHRs, but most of the benefits accrue to payers and purchasers. The lack of interoperability is also pivotal. Others include capital and risk tolerance; physicians' resistance related to time concerns, fears about privacy, system maintenance, the number of vendors in the marketplace, and the transience of vendors. The key initial policy changes will be those addressing financial incentives and interoperability.