4.9 paper as a marker of resistance to change
Paper use may also be due to a resistance to change. In this particular study setting, the EHR was implemented about 10 years ago, so there was perhaps less resistance to change in terms of moving to an EHR in general, and more of a resistance to change as it relates to certain components of the EHR, such as order entry and viewing certain results. For example, we reported a case where physicians viewed printed MRI results instead of the electronic report. This seems to be in part a training or EAR usability issue in that some physicians simply do not know how or where to view the MRI report in CPRS and instead rely on the nurse or office manager to print the report for them when it becomes available. Thus, the physicians who rely on the nurses or office manager to print the report for them may not have the motivation or need to access the report electronically themselves, perhaps for some of the reasons listed in Table 2, and these scenarios indicate a reluctance to change to electronic processes.