J Am Med Inform Assoc 12:3-7 doi:10.1197/jamia.M1664
  • Focus on Electronic Health Records: ACMI Symposium 2004
  • Review Paper

Will the Wave Finally Break? A Brief View of the Adoption of Electronic Medical Records in the United States

  1. Eta S Berner,
  2. Don E Detmer,
  3. Donald Simborg
  1. Affiliations of the authors: Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL (ESB); American Medical Informatics Association, Bethesda, MD and Department of Health Evaluation Sciences, University of Virginia, Charlottesville, VA (DED); iKnowMed, Inc., Berkeley, CA (DS)
  1. Correspondence and reprints: Eta S. Berner, EdD, Health Informatics Program, Department of Health Services Administration, School of Health Related Professions, 1675 University Boulevard, Room 544, University of Alabama at Birmingham, Birmingham, AL 35294-3361; e-mail: <eberner{at}>
  • Received 5 August 2004
  • Accepted 20 September 2004


For over thirty years, there have been predictions that the widespread clinical use of computers was imminent. Yet the “wave” has never broken. In this article, two broad time periods are examined: the 1960's to the 1980's and the 1980's to the present. Technology immaturity, health administrator focus on financial systems, application “unfriendliness,” and physician resistance were all barriers to acceptance during the early time period. Although these factors persist, changes in clinicians' economics, more computer literacy in the general population, and, most importantly, changes in government policies and increased support for clinical computing suggest that the wave may break in the next decade.


  • Based on the presentations given by Drs. Detmer and Simborg at the February 2004 ACMI Symposium and on a presentation by Dr. Berner as a Teaching Scholar at the University of Arkansas Medical School in March 2000.

  • The authors thank the other ACMI Symposium participants for their contributions in discussions on these issues.

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