الفهرس 
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Abstract
Information technology has been integrated in healthcare industry. EMRs is the major aspect of its innovation. Despite the old and long history of the EMRs, its implementation is still far away from the desired target especially in the developing countries. Although the benefits of its implementation were documented in many studies, there were many obstacles for its implementation and usage. Physicians are the end users of EMRs, so their acceptance, attitude and satisfaction are the corner stones for the success of the implementation process. This can be noticed in their usage of the EMRs. No studies were noticed in Egypt discussing the attitude and usage of physicians towards EMRs.
Aim of the study
To assess physicians’ usage, attitude and satisfaction with Electronic Medical Records (EMRs) with investigation of some factors influencing them in a private hospital in Alexandria. Also to identify the obstacles for EMRs Usage.
Target population and study sample
A Cross-sectional study design was conducted on all full time physicians who are working in a private hospital (all departments) for at least 3 months. Also the monthly evaluation reports of quality department of the hospital that evaluate each physician in the aspects of usage of EMRs for clinical data entry and progress notes of his cases.
Data Collection methods and tools
1. Pre-structured Self-administered questionnaire was used to collect data from the physicians.
2. Physicians’ usage evaluation reports for the preceding year (2016) were obtained from the quality department of the hospital.
The results of the present study revealed the followings:
• The usage of the physicians of EMRs was variable between the functions of EMRs. It was highest in ordering medications and ordering laboratory and radiological investigations through the EMRs. It was lowest in the registration of the medical complications of the disease or the operation.
• Two thirds of the physicians were fair users, while 28.2% of them were good users and only 9.9% were bad users.
• Usage was affected by age, young physicians are more using it than elder ones. Also it was affected by specialty, the clinical pathology physicians were the best users, while general surgery physicians were the lowest specialty. But it was not affected by gender, daily internet usage or the courses the physicians received before.
• The attitude of more than half of the physicians were positive, only 2.8% of them had negative attitude. It was mostly affected by perception of the physicians that (EMRs benefits outweigh the costs and users’ efforts) and (EMRs improve the quality of care) in a positive way. On the other hand the attitude affected negatively by (EMRs facilitate sharing the information between the departments and organizations easily).
• Attitude was affected by age, younger physician had more positive attitude than elder physicians. No other factors affect it. There is positive correlation between usage and attitude.
• The satisfaction of the physicians with the EMRs was most in technical support. More than half of the physicians had low satisfaction with EMRs and only 6.6 % had high satisfaction with EMRs.
• Satisfaction was affected by age (elder physicians had higher satisfaction than younger age group. It is not affected by gender, specialty or previous experience and courses obtained in electronic records.
• Satisfaction has a positive relationship with attitude and negative relationship with usage.
• Barriers are varied according to their perception from the physicians the most important barriers were the financial barriers including the startup and ongoing costs.
• Technical barriers are less important as most of the physicians had good experience in the software. The presence of IT (information technology) department dedicated for technical help makes the technical barriers easy to overcome.
• The social barriers in the study also represent a problem due to absence of the EMRs in most other hospital, so lack of support represent a problem. Also the internal auditing may affect the doctor patient relationship.
The following recommendations were suggested:
1) The physicians should be involved in the implementation process of EMRs.
2) The physicians should receive initial and ongoing training for EMRs.
3) There should be incentives for EMRs usage.
4) EMRs should be implemented in most hospitals as soon as possible.
5) The usage of the physicians should monitored regularly and give them feedback.
6) Satisfaction survey to be done every now and then to facilitate the obstacles they encounter in the usage.
7) Further researches are required for:
• Cost benefit analysis of EMRs implementation in developing countries.
• Standardization of the EMRs applications for Hospitals.
• Post-Interventional study should be conducted after training program on EMRs usage.