Graduation Date

Summer 8-11-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research, Administration, and Policy

First Advisor

Wael ElRayes


Computerized tasks represent an essential component of the modern health care services. A substantial part of these computerized tasks performed by physicians are made for documenting clinical care through Electronic Health Records (EHRs) and using Prescription Drug Monitoring Programs (PDMPs). While these computerized tasks have positively impacted the care provided by physicians, difficulty-based barriers to using these electronic tools were identified. Given the potential unfavorable roles that difficulty-based barriers can play in the provision for health care, it is important to examine factors associated with these barriers. Thus, the core objective of this study is to examine factors associated with the difficulty of documenting clinical care through EHRs and using PDMPs among office-based physicians in the United States.

Using nationally representative data from the 2019 National Electronic Health Records Survey (NEHRS), several statistical analyses were used to conduct this study including bivariate Chi-Square tests, multivariate logistic regressions, and causal mediation analyses with a confidence interval of 95%. The poststratification weighting option was used throughout our statistical analyses to produce unbiased estimates of nationally representative data and to account for nonresponses and complex sampling design.

Our findings revealed an underexamined correlations between these difficulty-based barriers and the examined factors. Specifically, the difficulty of clinical care documentation was associated with physicians’ dissatisfaction with EHRs and reduction in direct physician-patient time during clinical visits. Additionally, the difficulty of PDMP use was associated with several factors including the reduction or elimination of controlled substance prescriptions, frequency of PDMP check prior to prescribing controlled substance prescriptions to a patient for the first time, change of controlled substance prescriptions to non-opioid pharmacologic or non-pharmacologic therapy, and request of PDMP data from other states.

Despite the substantial benefits of electronic tools to support the provision of care, the difficulty barrier in performing and completing the computerized tasks of documenting clinical care and using PDMPs still exists. Unfavorable influence on the provision of care can result as implications to changes in these factors. Further research is needed to evaluate the influence of these difficulty-based barriers on the quality and safety levels of the related health care services.


2023 Copyright, the authors

Available for download on Sunday, July 13, 2025