Journal of Medical Systems

, Volume 36, Issue 5, pp 3141–3149 | Cite as

Use and Satisfaction with Electronic Health Record by Primary Care Physicians in a Health District in Brazil

  • Alexandre Alcantara Holanda
  • Henrique Luis do Carmo e Sá
  • Anya Pimentel Gomes Fernandes Vieira
  • Ana Maria Fontenelle Catrib
Original Paper


It is believed that Electronic Health Records (EHR) improve not only quality of care but also patient safety and health care savings. This seems to be true for developed countries but not necessarily in emerging economies. This paper examined the primary care physicians’ satisfaction with a specific EHR in a health district of a major city in Brazil and describes how they are using it as well as its specific functions. A cross-sectional questionnaire survey with all physicians from all Community Health Centers of the 6th health district of the City of Fortaleza that were using HER was conducted. From the 111 subjects (100%), a total of 99 physicians answered the survey (89% response rate). For overall satisfaction with the EHR, 2 (2%) were satisfied, 50 (50.5%) were satisfied in part and 47 (47.5%) were not satisfied. For the functionalities, a proportion of correct answers (PCA) and an index of functionality usage (IFU) were developed. PCA and IFU were significantly correlated (p < 0.001). Inverse and weak correlations were found between PCA and age (p < 0.001), years since medical school and years of work (p < 0.01). For usage (IFU), there was inverse correlation with “years working in Family Health Strategy” (p < 0.05). High IFU was associated with physicians who stated to use easily Internet and Email; who saw less patients per half-day; who were women (p < 0.05), younger (p < 0.05), in training (p < 0.05) and not satisfied with the EHR (p < 0.05).The use of EHR was associated with being young, female, still in training and seeing less than 16 patients per half-day. Structural issues (e.g. network and system support) seemed to be major barriers in this setting. Lack of classical functionalities such as problem list and clinical reminders could have contributed to exacerbate misperceptions about what EHRs can do in improving work processes and patient care.


Medical records systems Computerized Primary health care Developing countries Ambulatory care Health services evaluation 



To the University of Fortaleza and those professional (medical doctors) who participated in this research.

Competing interests

The author(s) declare that they have no competing interests

Authors’ contributions

This manuscript is a result of the master dissertation of AAH, participating in all stages of this research, including, design of the study, data collection, data analysis and draft of the manuscript. The author AMFC was the main supervisor for this study, participating in the design of the study, critical analysis of the data and draft of the manuscript. APGFV and HLCS were co-supervisors of this study, giving support in the methodological approach, statistical analysis, critical review of the results and draft of the manuscript.


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alexandre Alcantara Holanda
    • 1
  • Henrique Luis do Carmo e Sá
    • 1
  • Anya Pimentel Gomes Fernandes Vieira
    • 2
  • Ana Maria Fontenelle Catrib
    • 2
  1. 1.Universidade de Fortaleza School of MedicineFortalezaBrazil
  2. 2.Public Health Master ProgramUniversidade de FortalezaFortalezaBrazil

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