Objective Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology penetration.

Design and measurements A representative sample of 949 doctors (response rate = 77.0%) was asked, through a postal survey, to rank a list of nine barriers associated with clinical computerization by self-perceived importance. Similarly, they ranked seven incentives or catalysts that might influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation.

Results Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better quality care were ranked highest as potential incentives to computerize. Cost vs non-cost, physician- vs patient-related, and monetary vs non-monetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and push vs pull factors accounted for the incentive variables. There were four clusters identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts towards computerization. Those who found the potential interference with communication important also believed that the promise of improved quality care from computerization to be a significant incentive.

Conclusion This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that might be employed to accelerate uptake of computer systems.