JMIR Publications

ABSTRACT

Background:

Numerous publications show that Electronic Medical Records (EMR) may provide an important contribution to increasing the quality of care. There are indications that particularly the medical specialist plays an important role in the use of EMRs in hospitals.

Objective:

The aim of this study is to examine how and by which aspects the relationship between EHR use and quality of care in hospitals is influenced according to medical specialists.

Methods:

To answer this question, a qualitative study was conducted in the period August until October 2018. Semi-structured interviews of around 90 minutes were held with eleven medical specialists of eleven different Dutch hospitals. For the analysis of the answers, we used a previous published taxonomy of factors that can influence the use of EMRs.

Results:

The experience of the participating medical specialists varied between 5 and 27 years. Using a previously published taxonomy, the medical specialists considered technical barriers as the most significant for EMR use. The suboptimal change processes surrounding implementation are also perceived as a major barrier. A final major problem is related to the categories ‘social’, the relation with the patient and fellow care providers, and ‘psychological’, based on their personal issues, knowledge, perceptions, and ‘time’, the time required to select, implement and learn how to use EMR systems, and then to enter data into the system. On the positive side, they also identified potential technical facilitators, particularly in the assured availability of information to all health professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve quality of care, but consider these capabilities currently lacking.

Conclusions:

The eleven medical specialists shared positive experiences of EMR use in comparison with the former recordings on paper. The fact that involved health professionals can access the patient data at any time they need it, is considered important. However, in practice, potential quality improvement lags behind as long as decision support cannot be applied by lack of a fully coded patient record. Prior to how to improve the available processes comes the basic question: Are the historically available processes of diagnosis making and treatment the right ones? If not, the requirements for supporting IT-system must then be deviated from the newly designed processes. Important in this approach is that the possibilities of decision support are taken as a starting point. Clinical Trial: Not Applicable