Implementation of electronic medical records: theory-informed qualitative study

Abstract

Objective: To apply the diffusion-of-innovations theory to the examination of factors that are perceived by family physicians as influencing the implementation of electronic medical records (EMRs).

Design: Qualitative study with 2 focus groups 18 months after EMR implementation; participants also took part in a concurrent quantitative study examining EMR implementation and preventive services.

Setting: Toronto, Ont.

Participants: Twelve community-based family physicians.

Methods: We employed a semistructured interview guide. The interviews were audiotaped and transcribed verbatim; 2 researchers independently categorized and coded the transcripts and then met to compare and contrast their findings, category mapping, and interpretations. Findings were then mapped to an existing theoretical framework.

Main findings: Multiple barriers to EMR implementation were described. These included lack of relative advantage for many processes, high complexity of the system, low compatibility with physician needs and past experiences, difficulty with adaptation of the EMR to the organization and adaptation of the organization to the EMR, and lack of organizational slack. Positive factors were the presence of a champion and relative advantages for some processes.

Conclusion: Early EMR implementation experience is consistent with theoretical concepts associated with implementation of innovations. A problematic implementation process helps to explain, at least in part, the lack of improvement in preventive services in our quantitative results.

Figure 1.

Theoretical factors affecting implementation of an innovation: A) Innovation attributes that positively (+), negatively (−), or inconclusively (0) affect implementation; B) Organizational attributes that positively (+) or inconclusively (0) affect implementation.