Summary of barriers and success factors for implementation of EMRs in clinicians’ offices
| ARTICLE | STUDY DETAILS | SUCCESS FACTORS | BARRIERS |
|---|---|---|---|
| Boonstra and Broekhuis,6 2010 | Review of 22 articles concerning barriers to EMRs as perceived by physicians (17 American, 2 Canadian, 1 Israeli, 1 Irish, and 1 Norwegian study) | • Treat EMR implementation as a change project led by quality change managers | • Financial • Technical • Time • Psychological • Social • Legal • Organizational • Change process |
| Terry et al,12 2009 | 30 new users in southwestern Ontario | • Assess computer skills before implementing the system • Retain a full-time “superuser” for consultation | • Poor staff computer literacy • Frustration with navigating the system |
| Denomme et al,11 2011 | Follow-up of 19 of 30 users from a previous study | • Training to ensure consistent use by all staff • Retaining a full-time “superuser” • Improved internal communication | • Need for consistent input into EMR • Lack of enthusiasm for efficient use |
| Paterson et al,13 2010 | Interviews in 20 clinics encoded 3749 physician comments and assigned 20 themes (2 clinics per province, except 4 in ON, 3 in QC, and 1 each in the Maritime provinces) | • Personal leadership and commitment • Funding • Management change • Payment model • Collaborative culture • Integrated business and clinical aspects • Consistent, reliable data • Improved quality of care • Legibility of notes | • Lack of interoperability with other systems • Need to scan documents from non-EMR systems into patient EMRs |
| Ludwick and Doucette,9 2009 | Semistructured interviews at AB clinics | NA | • Time constraints • Insufficient computer skills • Complex HIT user interfaces • Fee-for-service remuneration model • Poor vendor support |
| Gagnon et al,19 2010 | 15 semistructured interviews of family medicine groups in QC | • A “champion” combining roles of clinical technology and knowledge • Supportive organization open to change • Locally adapted implementation strategy | NA |
| Rozenblum et al,18 2011 | Interviews with 29 stakeholders: national, AB (most advanced), BC (moderately advanced), and ON (least advanced) | • Funding • National standards • Patient registries • Digital imaging | • Lack of electronic health policy • Inadequate clinician involvement • Lack of a business case to use EMRs • Focus on national not regional interoperability |
| Lau et al,14 2012 | Systematic review of EMR use and effect on practice worldwide | • Micro: user support aids adoption • Meso: better productivity and work flow • Macro: funding incentive to change | NA |
| Price et al,17 2013 | 57 interviews in clinics using EMRs > 6 mo in MB | NA | • Ceiling effect of current technology • Underuse owing to lack of awareness of EMR functionality |
| Kuhn and Lau,20 2014 | Study in 1 Canadian jurisdiction 4 y after EMR implementation; 46 surveys on EMR use, benefits, system, and service; paired with extraction of actual system log data on EMR use | • Relevant, accurate, complete information • Perceived enhanced efficiency • Perceived improvement in continuity of care | • Training limitations • Security of information concerns |
AB—Alberta, BC—British Columbia, EMR—electronic medical record, HIT—health information technology, MB—Manitoba, NA—not applicable, ON—Ontario, QC—Quebec.