Electronic medical records promise to be the gateway to the future of health care, but as convenient and helpful as they may be, adoption among doctors is happening at a slow rate. 

Steep upfront costs associated with digital medical charts and privacy concerns are making doctors reluctant to embrace digital record keeping. 

According to a recent survey published in the New England Journal of Medicine, only 4% of U.S. physicians providing direct patient care said they had a full EMR system and only 13% had a basic system. 

Electronic medical record systems [EMRs] aid physicians in keeping track of patients. They can also cut down on medical errors and automate tasks, like faxing prescriptions directly to pharmacies. But as helpful as these systems can be, they’re not free, which has been a hurdle to wide-scale adoption.

According to Jim King, president of the American Academy of Family Physicians, the main cost is the licenses for EMR software. Doctors need to purchase computers as well as a server to back up data. These direct costs can cost upward of $30,000 per physician and the indirect costs of training the staff to use it and maintaining the system can add thousands more, he said.

The California HealthCare Foundation recently took a snapshot to see how practices were adopting EMRs and found cost was a major concern.

“It was pretty clear that the single biggest barrier was the expense of purchase. Next was the difficulty of implementation,” said Jonah Frohlich, senior program officer at the California HealthCare Foundation.

Indeed, the New England Journal of Medicine survey found that of the doctors who did not have an EMR system, 66% said it was too expensive.

On top of the cost, another issue is patients’ reluctance to have their medical data housed on a computer that could be misused or infiltrated by hackers. “People are worried about their privacy and it’s a legitimate concern,” said Frohlich.

There are laws in place to protect patients whether their records are electronic or handwritten. HIPAA, short for Health Insurance Portability and Accountability Act, creates two classes of entities: covered entities (who provide care) and business associates (who are involved in care, but don’t provide it), said Frohlich. These organizations have access to medical records, but can't share them with anyone except other covered entities for the purpose of direct patient care. He added that electronic records can be more secure than handwritten ones since they leave an audit trail so you can see who has accessed them.

Frohlich did warn that people should keep an eye on services offered by companies like Google (GOOG) and Microsoft (MSFT), which have their own online health care portals, Google Health and Microsoft HealthVault.

“Because Google isn’t a business associate or a covered entity, it’s not bound by HIPAA,” he said.  Though these companies can’t access your records without you signing up for their services and requesting that your doctor enter your information into them, Frohlich said more needs to be done to protect privacy in that arena.

As for the potential for hackers, King of the American Academy of Family Physicians said electronic medical records are not much different than online banking, with a caveat: individual practices are primarily responsible for keeping data safe.

“I think most practices want to protect the privacy and records of their patients. A lot of recent events brought things to light that changed policies and helped. But it still comes down to the integrity of those who have the information, the doctors,” he said.

Just a few months ago, for example, an employee at the UCLA Medical Center breached  Maria Shriver's medical records, in addition to those of several other celebrities and politicians.

While adoption of EMRs is taking place at a slow rate, King said that could increase in the next five to 10 years since medical students coming out of school are demanding it and in some cases refusing to work for practices that don't use EMRs.

The New England Journal of Medicine survey echoed this, with 26% of doctors without EMR systems stating they planned on buying one within the next two years.

“There is a learning curve with these systems so productivity goes down a bit, but after a year that levels off. Most (practices) see by 18 months they’re back where they were in terms of efficiency and with better quality of care,” said King.Not only does quality of care tend to improve with these systems, but there can also be cost savings for physicians, added Frohlich of the California HealthCare Foundation.

“It’s a return on investment issue. Physicians, when they implement an EMR, might also integrate a billing system and when they do that they may document what they’re doing for the patient better and generate other billing items,” he said. “When the clinical documentation, transcription, billing, and charts are all integrated and a patient can go online to request appointments and prescription refills, this creates a lot of savings for front and back end offices of practices.”