Michael Ciampi runs a family medical practice in Portland, Maine, that’s still entirely reliant on paper records. He has no plans to implement an electronic health records system anytime soon. Ciampi doesn’t have anything against technology, but a failed attempt to go electronic several years ago left him frustrated. “What we found was a system that just wasn’t patient-centered,” Ciampi says. “The primary function was to enhance billing, not to build a physician-patient relationship. Our productivity went down 25 percent.”

About one-fifth of doctors don’t have an electronic health record system, commonly called an EHR, implemented in their offices. For those who do, frustrations with the technology are well documented. Only 34 percent of doctors surveyed by the American Medical Association said they were happy with their electronic systems.

Since 2009, the Obama administration has been offering financial incentives to certain doctors and hospitals that can demonstrate “meaningful use” of EHRs; incentives can amount to as much as $63,000. This was likely a big reason the number of doctors using EHRs jumped to 50 percent in 2013 and then to 75 percent by the end of 2014.

But the incentive program is going to be phased out by the end of the year, which leaves some wondering what can be done to reach physicians who still rely mostly on paper. Andy Boyd, a professor of health information sciences at the University of Illinois at Chicago, sympathizes with the holdouts. “If you have a smaller practice, it’s expensive,” Boyd says. “You also can’t see the same number of patients while you get used to the system.”

For a five-physician clinic, the initial cost to implement an EHR is around $162,000. Additional maintenance expenses in the first year can be around $85,000. And Boyd often hears complaints from doctors about the interface, which they say wasn’t designed with a clinician in mind. “I spoke with a doctor who was getting so frustrated with his EHR, the patient was actually getting concerned about the doctor’s own health,” he says.

For rural clinics, the problem isn’t so much implementation as maintenance, says Alan Morgan, CEO of the National Rural Health Association. Rural physicians often have trouble getting IT support and access to high-speed broadband, which is necessary to run an EHR properly. Still, Morgan encourages physicians -- rural or not -- to be patient as EHR technology evolves. “We now have the ability to track a patient as they move through the health-care system, and we’re going to keep moving toward more of that kind of intelligence,” he says. He thinks that EHRs, by helping physicians manage their finances and patient populations, could help stem the tide of closures of rural hospitals and doctor’s offices.

In Portland, Ciampi is not saying “never ever” to EHRs. He’ll make the switch, he says, only when interfaces become more patient-centered and easier to use than his trusty paper charts. And there is the issue of patient privacy. “Paper charts are unhackable, and patient confidentiality means a lot to us,” Ciampi says.

Boyd acknowledges that it will take some time before EHRs are in every doctor’s office. “Doctors have had paper records for almost 100 years, and they got really good at it,” he says. “We are only in the early aughts of EHRs. We have a lot to learn.”