ABSTRACT:The electronic medical record (EMR) is an enabling technology that allows physician practices to pursue more powerful quality improvement programs than is possible with paper-based records. However, achieving quality improvement through EMR use is neither low-cost nor easy. Based on a qualitative study of physician practices that had implemented an EMR, we found that quality improvement depends heavily on physicians' use of the EMR-and not paper-for most of their daily tasks. We identified key barriers to physicians' use of EMRs. We then suggest policy interventions to overcome these barriers, including providing work/practice support systems, improving electronic clinical data exchange, and providing financial rewards for quality improvement.I n f o r m at i o n t e c h n o l o gy i s i nc r e a s i n g ly r e c o g n i z e d as an important tool for improving patient safety and quality of care, especially by promoting the practice of evidence-based medicine.1 Of all the health information technology (IT) in current use, the electronic medical record (EMR) has the most wide-ranging capabilities and thus the greatest potential for improving quality. Research has demonstrated the quality benefits of electronic documentation and viewing, prescription and test ordering, care management reminders, and messaging, among other EMR functions. 2Despite this potential for quality improvement, however, few physician practices use EMRs. Nevertheless, interest in EMRs is substantial.3 In a survey of 1,200 mostly solo/small physician groups, less than 13 percent of respondents said that their practice had EMRs; 32 percent expressed interest in EMRs, and half of these were "very interested." 4 Clearly, the EMR is of growing importance for many physician practices.In this paper we present key results of our qualitative study on the opportuni-1 1 6 M a r c h /A p r i l 2 0 0 4 P u r s u i t O f Q u a l i t y

Although the promise of clinical decision support system-facilitated evidence-based medicine is strong, substantial work remains to be done to realize the potential benefits.