I recently had to find my immunization records, which apparently were never transferred to my new doctor’s office years ago. After locating the records, split between two offices, I also needed to find a fax machine where I could receive them. One record turned out to be a photocopy of an original handwritten document from around the time the Berlin Wall came down in the last days of the 80s.

In an age when nearly everything is accessible through an app, doctors using pagers and recording notes by hand are still common, with some dictating to a tape-recorder for later transcription by an assistant. Why is the healthcare industry so slow to adopt new technology, specifically information technology and modern electronic medical records (EMRs)?

“It’s never needed to change,” says Bruce Broussard, CEO of health insurance company Humana. “I think what you’ll see over time is more forced competition. The consumer has had very little choice over the years… You go to the hospital because you gave to go the hospital… You might pick one over the other, but they’re all the same. What we’re seeing with the healthcare exchanges and Medicare Advantage is that there’s more competition, and that competition will drive more change. But it will be slow. Healthcare has never been a taker of technology.”

The problem is not new, as Broussard mentions, and it’s not limited to EHRs. And while the lack of pressure, prior to the Meaningful Use incentive program, has certainly played a role, it’s also not that simple.

Scholarly articles have consistently identified six barriers to implementation of new technology in medicine: cost, legality, time, fear, usefulness, and complexity, according to the literature review for an article in Perspectives in Health Information Management.

Cost – EHRs show a pretty clear example of this; HealthIT.gov offers an estimate of $33,000 average upfront cost, per provider, for an in-office system, and $4000 in yearly costs. On average, software as a service (SaaS) systems are cheaper upfront ($26,000), but cost $8000 after. For medical devices, costs can be far greater: $500,000 for a new LASIK laser, or $3 million for a top MRI machine.

Legality – With EHRs, the top legal issue is privacy; security is more tightly regulated for electronic records than for paper. Even if a well-designed electronic system is more secure, the legal risks can be daunting.

Time and Complexity – Many physicians are over-booked, possibly in part due to the reported (and reportedly growing doctor shortage. Taking time to learn a new, complex system means either decreasing time with each patient, decreasing the number of patients seen, or increasing time at work. And the complexity of the system might seem to be a permanent detractor, relative to the simple ease of hand-written notes.

Fear – This seems largely tied to the other factors: fear that a new system will increase costs, difficulty, and time, without offering sufficient benefits to offset the drawbacks. And the fear of legal issues in the form of medical malpractice suits pervades all aspects of the industry in this era.

Usefulness – While the medical community tries to adopt technology quickly if it promises to improve care directly, even with costly devices like the laser and MRI mentioned above, doctors often question the usefulness of information technology. If it doesn’t relate directly to care, and the old system works, it can be difficult to see the enormous potential benefit of a new system — at least until their peers are using the new technology, with clear advantages.

Despite these barriers, medicine is changing, in large part because the government’s heavy incentivization of EHRs. That systemic shift will likely encourage more rapid technology adoption overall, as electronic records become the norm and the benefits of greater connectivity become more obvious.