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I believe the resistance in Primary Care to EHR is a reflection of the cynicism that has become pervasive. The enthusiastic primary care docs are the ones doing lots of procedures(indicated?) and satisfying demand. You mentioned the 80% costs on chronic care. Most docs can name these 20% of their practice off the top of their heads(without an EHR) and their definition of improved care is to SEE THEM LESS.. Since the marginal improvement one obtains( 1-2 less hospital admissions, 1-2 less ER visits/ year) is such an incremental improvement, most primary care docs dismiss this success.
And it is hard to quantify.
So the problem, as you stated, really comes down to what does the physician expect from an EHR. There are lots of good products...We installed and ran Logician(Centricity) for 7 years in a primary care office. Paid for it ourselves, with no government support,,,,And now we have a huge data base that we don't have the time or capital(manpower) or enthusiasm to institute quality improvement...

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