Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada

Paré, Guy; Raymond, Louis; Guinea, Ana Ortíz de; Poba‐Nzaou, Placide; Trudel, Marie-Claude; Marsan, Josianne; Micheneau, Thomas

doi:10.1016/j.ijmedinf.2015.07.005

Cited by 35 publications

(34 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The implementation of EHR systems and other health information technology initiatives in support of health care delivery has become common in countries' national healthcare systems (e.g. [16][17][18][19][20][21][22].A n important stream of research that analyses EHR systems has focused on patient concerns about the dimensions of patient-oriented usability [23,24], privacy [25,26] and security [27,28], but the focus of this article is on clinicians as end-users of Bru-HIMS, and on the organisational management challenges associated with the implementation of health information technologies [29].…”

Section: Theoretical Contextmentioning

confidence: 99%

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

Sidek

Martins

2017

International Journal of Medical Informatics

View full text Add to dashboard Cite

Section: Theoretical Contextmentioning

confidence: 99%

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

Sidek

Martins

2017

International Journal of Medical Informatics

View full text Add to dashboard Cite

“…Note that following our investigation’s data collection phase, quantitative studies have further shown the presence of the ceiling effect detected by Price et al [20] in Canada [17, 30, 31]. To provide a deeper understanding of elements leading to a ceiling effect in EMR usage, we conducted a qualitative research using a multiple case study method.…”

Section: Methodsmentioning

confidence: 93%

“…A quantitative survey preceded this study and found that a majority of primary care practices did not use most of their advanced EMR functionalities, despite their availability [31]. We were therefore confident to find a ceiling effect in any site we would approach.…”

Section: Methodsmentioning

confidence: 96%

Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices

Trudel

Marsan

Paré

et al. 2017

BMC Med Inform Decis Mak

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…We can contrast these findings with those of prior studies about the use of laboratory-related capabilities in electronic health record (EHR) systems. In recent studies, while a vast majority of family physicians mentioned that their EHR system allowed them to view laboratory results and used such functionality, other core capabilities such as electronic ordering and tracking of laboratory tests were found to be much less available in these systems and, hence, much less used (e.g., [23,46]).…”

Section: Discussionmentioning

confidence: 99%

Advancing laboratory medicine in hospitals through health information exchange: a survey of specialist physicians in Canada

Raymond

Maillet

Trudel

et al. 2020

BMC Med Inform Decis Mak

Self Cite

View full text Add to dashboard Cite

Background: Laboratory testing occupies a prominent place in health care. Information technology systems have the potential to empower laboratory experts and to enhance the interpretation of test results in order to better support physicians in their quest for better and safer patient care. This study sought to develop a better understanding of which laboratory information exchange (LIE) systems and features specialist physicians are using in hospital settings to consult their patients' laboratory test results, and what benefit they derive from such use. Methods: As part of a broader research program on the use of health information exchange systems for laboratory medicine in Quebec, Canada, this study was designed as on online survey. Our sample is composed of 566 specialist physicians working in hospital settings, out of the 1512 physicians who responded to the survey (response rate of 17%). Respondents are representative of the targeted population of specialist physicians in terms of gender, age and hospital location.Results: We first observed that 80% of the surveyed physicians used the province-wide interoperable electronic health records (iEHR) system and 93% used a laboratory results viewer (LRV) to consult laboratory test results and most (72%) use both systems to retrieve lab results. Next, our findings reveal important differences in the capabilities available in each type of system and in the use of these capabilities. Third, there are differences in the nature of the perceived benefits obtained from the use of each of these two systems. Last, the extent of use of an LRV is strongly influenced by the IT artefact itself (i.e., the hospital's LRV available capabilities) while the use of the provincial iEHR system is influenced by its organizational context (i.e. the hospital's size and location). Conclusions:The main contribution of this study lies in its insights into the role played by context in shaping physicians' choices about which laboratory information exchange systems to adopt and which features to use, and the different perceptions they have about benefits arising from such use. One related implication for practice is that success of LIE initiatives should not be solely assessed with basic usage statistics.

show abstract

Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada

Cited by 35 publications

References 52 publications

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective

Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices

Advancing laboratory medicine in hospitals through health information exchange: a survey of specialist physicians in Canada

Contact Info

Product

Resources

About