Bulgarian physicians and nurses vs. electronic health records as a major issue of e-health

Introduction. Despite the numerous e-health applications, e-health cannot be implemented without the development and implementation of electronic health records (EHRs). The main barriers to the deployment of its systems are the lack of funding, infrastructure, capacity and legal framework, as well as the insufficient computer literacy of medical staff. Aim . The aim of this article is to assess the computer literacy of Bulgarian physicians and nurses, their attitude to e-health, especially EHRs as a major issue of e-health, including the ownership of medical data. Material and Methods . An enquiry comprising 33 questions is used. Respondents of the study are physicians and nurses from five regional and university hospitals in the North-eastern region of Bulgaria. Some of the results are compared to those of a study, carried out in 1999 among the physicians in Bulgaria. Several signs are discussed: self-evaluation of the experience in using computers, general attitude to eHealth, attitude to EHRs, including ownership of medical data. Results . The overall self-evaluation in using computers is 4.16 for physicians and 3.74 for nurses (max=6.00). The greatest need for additional training is in the use of statistical (47.98% of the physicians and 39.24% of the nurses) and specialized software (48.34% of the physicians and 49.65% of the nurses). Only 17.7% of the physicians and 14.89% of the nurses are familiar with the principles of e-health. Only 21.8% of the physicians and 25.8% of the nurses consider that the country is ready for the implementation of e-health. Almost all, 90.4% of the physicians and 82% of the nurses recognize the need for EHRs. About half of the physicians (46.1%) and 22.2% of the nurses would use an EHR system if they have adequate software. Physicians and nurses are not aware of what actually EHRs are. Most (74.5%) of the physicians and 69.3% of the nurses consider the implementation of personal health cards (presumably PHR), as a prerequisite for the implementation of e-health. The two preferred suggestions for the ownership of medical data are general practitioners (preferred by 28.3% of the physicians in 1999, 30.9% - in 2013, and 40.55% of the nurses) and the patient himself, preferred by 10.4% of the physicians in 1999, 29.38% - in 2013 and 26% of the nurses. Conclusions . Bulgarian physicians and nurses need additional education and training in using specialized, graphical and statistical software. The overall computer literacy of Bulgarian physicians and nurses is not adequate for the use of EHRs. They need additional education on the principles of eHealth, including EHRs, i.e. education in health informatics.