BackgroundThere has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians’ progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a “tiered ceiling effect” and then we show why such phenomenon occurs.MethodsWe conducted in-depth case studies in three primary care medical practices in Canada where physicians had been using EMR systems for 3 years or more. A total of 37 semi-structured interviews were conducted with key informants: family physicians (about half of the interviews), nurses, secretaries, and administrative managers. Additional information was obtained through notes taken during observations of users interacting with their EMR systems and consultation of relevant documents at each site. We used abductive reasoning to infer explanations of the observed phenomenon by going back and forth between the case data and conceptual insights.ResultsOur analysis shows that a ceiling effect has taken place in the three clinics. We identified a set of conditions preventing the users from overcoming the ceiling. In adopting an EMR system, all three clinics essentially sought improved operational efficiency. This had an influence on the criteria used to assess the systems available on the market and eventually led to the adoption of a system that met the specified criteria without being optimal. Later, training sessions focussed on basic functionalities that minimally disturbed physicians’ habits while helping their medical practices become more efficient. Satisfied with the outcome of their system use, physicians were likely to ignore more advanced EMR system functionalities. This was because their knowledge about EMR systems came almost exclusively from a single source of information: their EMR system vendors. This knowledge took the form of interpretations of what the innovation was (know-what), with little consideration of the rationales for innovation adoption (know-why) or hands-on strategies for adopting, implementing and assimilating the innovation in the organization (know-how).ConclusionsThis paper provides a holistic view of the technological innovation process in primary care and contends that limited learning, satisficing behaviours and organizational inertia are important factors leading to the ceiling effect frequently experienced in the EMR system assimilation phase.
By providing the right information, at the right time to the right clinician, many IT solutions adequately support the laboratory testing process and help primary care clinicians make better decisions. However, several technological and organizational barriers require more attention to fully support the highly fragmented and error-prone process of laboratory testing.
BACKGROUND
As mental illness continues to affect one in five individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to lack of uptake by patients and providers.
OBJECTIVE
The specific objective of this project is to develop a web-based resource to support the engagement of mental health providers and patients in the use of digital mental health tools.
METHODS
The web-based resource was developed using a multi-method approach. We conducted: 1) an environmental scan and engagement of experts in the field; 2) an academic literature review; 3) a grey literature review; and 4) a stakeholder engagement workshop.
RESULTS
We developed a resource, which is now available publicly online, to support patients' and providers' engagement in the usage of digital mental health tools. Based on a literature review, environmental scan with 27 experts and an engagement workshop with 15 stakeholders, 25 resources were identified and included in the resource guide. The contents of the resource guide are directed at mental health care providers, administrators and patients/clients (inclusive of families/caregivers).
CONCLUSIONS
The resource guide is now publicly available online for free. Future work should explore how this document can be integrated into clinical care delivery and pathways.
Primary health care medical practices have made sizable information technology investments in recent years, primarily deploying electronic medical record (EMR) systems as well as Web‐based e‐learning applications. The basic assumption here is that developing information technology‐based knowledge management capabilities may significantly improve the innovation and clinical performance of these organizations. Increasing uncertainty in their environment requires them to develop greater absorptive capacity (ACAP), that is, an organizational learning capability to deal with the external sources of this uncertainty. In applying ACAP theory to primary care settings, this study seeks to answer the following research questions: What are the e‐learning and EMR capabilities developed by primary care medical practices in response to increasing environmental uncertainty? To what extent does the development of an e‐learning capability influence the development of an EMR capability? To what extent does building ACAP contribute to positive outcomes in terms of medical practices' innovation and clinical performance?
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