Implementation Of Electronic Medical Record Research Articles

A literature review: Security Aspects in the Implementation of Electronic Medical Records in Hospitals

Backgrounds: Electronic Medical Records have complete and integrated patient health data, and are up to date because RME combines clinical and genomic data, this poses a great risk to data disclosure The priority of privacy is data security (security) so that data will not leak to other parties. That way cyber attacks can be suppressed by increasing cybersecurity, namely conducting regular evaluation and testing of security levels.Objectives: To determine the security technique that maintains privacy of electronic medical records.Methods: This type of research uses a literature review methodResults: Data security techniques are determined from each type of health service. Data security techniques that can be applied are cryptographic methods, firewalls, access control, and other security techniques. This method has proven to be a very promising and successful technique for safeguarding the privacy and security of RMEConclusion: Patient medical records or medical records are very private and sensitive because they store all data about complaints, diagnoses, disease histories, actions, and treatments about patients, so the information contained therein must be kept confidential. As well as the hospital as a medical record manager is required to apply for patient privacy data security techniques.

Exploring the Influence of Users' Characteristics in Continuance Intention to Use Electronic Medical Records (EMR): Extending the Expectation Confirmation Model (ECM).

Even though the "user characteristics" (UC) can influence "acceptance" and "the continuance intention to use" of information systems such as electronic medical records (EMR), the effect of UC has not been adequately evaluated in post-adoption models. This study seeks to examine the effect of UC on post-usage of EMR using the expectation confirmation model (ECM). A total of 450 questionnaires was collected by a survey to extend ECM by integrating UC using structural equation modeling (SEM). Data were analyzed using LISREL through confirmatory factor analysis. A path analysis test was also performed to fit and confirm the model fit. The UC affects the "confirmation of expectations" directly and the "continuance intention to use" indirectly. The findings of the present study can provide a new path for further research on the extending of the ECM model. Moreover, end users' characteristics should be considered in the preparation and training phases of EMR implementation.

A Note on End-User Requirements Elicitation for Electronic Medical Records Implementations

This paper summarises the arguments and counterarguments within the scientific discussion on the issue of the implementation of Electronic Medical Records (EMR). The primary purpose of the research is to present a framework for gathering end-user requirements in EMR system implementation. The cross-geographical literature review demonstrates EMR system implementation to be a complicated task to manage. A systematic review of literature sources and approaches for solving the problem indicates that a lack of end-user participation often results in technology rollbacks. The failures to implement electronic medical records are considered to be the reasons for financial losses, followed by the rearrangements of key personnel. The author of the article investigates the role of the main actors involved in the healthcare process. Consequently, as the market adoption of EMRs grows and its impact as a workflow management tool in care facilities increases, focusing on end-user requirements during the implementation phase becomes essential. Investigation of the topic reveals that the opposing points of view, learning investments, and the embedded nature of older technologies deter users from accepting new technology. Methodological research tools involved studying the workflows in a regular outpatient journey. Taking the case of a standard outpatient facility, the paper attempts to present its results through a framework for requirement gathering in the pre-implementation stages. A plan of action for eliciting end-user requirements for the users in a three-stage framework is being proposed. Considering the diverse number of actors in the standard outpatient journey, the three-stage framework breaks down requirements by roles and educational backgrounds and gathers into 1) antecedent or existing conditions; 2) formal and informal communication channels; 3) user and system-generated requirements. This framework relies on synthesising existing frameworks and arranging them in sequential order for real-world implementations based on existing research papers.

Readiness of Application of Electronic Medical Records in Bethesda Lempuyangwangi Hospital, Yogyakarta

Background: Based on the strategic plan of the Ministry of Health of the Republic of Indonesia for 20202024, all hospitals can gradually implement electronic medical records. However, there are still many obstacles experienced by hospitals in implementing Electronic Medical Record (EMR), readiness assessments can be used to determine readiness, indications and requirements in facilitating the implementation of EMR so as to avoid various obstacles during the implementation process. Subjects and Method: This was a qualitative descriptive study with a case study design. The study was conducted at Bethesda Lempuyangwangi Hospital, Yogyakarta, from May to June 2022. The data collected was the readiness to implement EMR in terms of organizational alignment and management capacity, by conducting indepth interviews with 7 people. The study subjects were determined by purposive sampling who were considered to have the capacity to make decisions related to EMR. Results: Bethesda Lempuyangwangi Hospital in implementing EMR from organizational alignment is said to be ready, the board of directors has known and understood that the implementation of RME has many benefits, the organization has been planned and the unit leadership understands the implementation risk in case of failure, to anticipate this, a longterm vision has been prepared. Readiness to implement EMR from management capacity can be improved because the IT committee has not yet been formed consisting of stakeholder representatives and hospitals, organization is still within the scope of the hospital, where ICT has been included in the organization's strategic plan. The roles and responsibilities for EMR implementation are defined with clear accountability to vendors and have been documented, the board of directors has considered planning the EMR implementation budget, funding for ongoing clinical IT adoption and the required standards are included in future planning and will be part of the IT budget. Conclusion: Bethesda Lempuyangwangi Hospital is ready to implement electronic medical records that will be applied to inpatient units, this can be seen from the alignment of the organization and management capacity where the culture, organization, leadership, strategy, information management, clinical staff, accountability and budget finance have been planned and have started held. Keywords: Readiness, Electronic Medical Record Correspondence: I Gusti Agung Ngurah Putra Pradnyantara. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: gustipradnyantara1997@gmail.com. Mobile: +62 82146804776. Journal of Health Policy and Management, (2022), 07(02): 149-157 https://doi.org/10.26911/thejhpm.2022.07.02.06

Implementation of Electronic Patient Medical Records: Problems of Legal Regulation in Ukraine

Implementation of Electronic Patient Medical Records: Problems of Legal Regulation in Ukraine

Development of Nursing Workflows and Device Requirement Principles with the Implementation of an Electronic Medical Record System.

The past decade has seen the implementation of electronic medical record (EMR) systems being implemented across large-scale healthcare organisations throughout Australia. A first-time implementation of an organisational-wide EMR system required a multi-modal approach to the development of new nursing workflows and appropriate selection of hardware devices to ensure acceptance and adoption of the EMR. The aim of this work was to develop new nursing workflows and associated device requirement principles to allow for continuation of safe, high quality nursing care with an EMR implementation. The incorporation of multi-disciplinary consultations, an audit, observational study and clinical and governance stakeholder engagement was used to develop device requirement principles. This ensured development of standardised nursing workflows were successfully adopted throughout the organisation with the EMR implementation.

Facilitators and Barriers to the Adoption of an Electronic Medical Record System by Intensive Care Nurses.

Introducing new technology, such as an electronic medical record (EMR) into an Intensive Care Unit (ICU), can contribute to nurses' stress and negative consequences for patient safety. The aim of this study was to explore ICU nurses' perceptions of factors expected to influence their adoption of an EMR in their workplace. The objectives were to: 1) measure psychological factors expected to influence ICU nurses' adoption of EMR, and 2) explore perceptions of facilitators and barriers to the implementation of an EMR in their workplace. Using an explanatory sequential mixed method approach, data were collected using surveys and focus groups. ICU nurses reported high scores for motivation, work engagement and wellbeing. Focus group analyses revealed two themes: Hope the EMR will bring a new world and Fear of unintended consequences. Recommendations relate to strategies for education and training, environmental restructuring and enablement. Overall, ICU nurses were optimistic about EMR implementation.

Older Nurses' Perceptions of an Electronic Medical Record Implementation.

In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses' perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses' adoption of the EMR; and 2) explore older nurses' perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.

Perioperative Nurses' Perceptions Pre-Implementation of an Electronic Medical Record System.

The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses' perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.

Understanding nurses’ perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study

BackgroundElectronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses’ perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. MethodsData were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. ResultsCoded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses’ most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). DiscussionIn addition to effecting changes in their work and workflows, the dominance of nurses’ emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses’ psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. ConclusionsMultifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.

Implementation of a pediatric early warning score tool in a pediatric oncology Ward in Palestine

BackgroundPediatric Early Warning Scores (PEWS) are nurse-administered clinical assessment tools utilizing vital signs and patient signs and symptoms to screen for patients at risk for clinical deterioration.1–3 When utilizing a PEWS system, which consists of an escalation algorithm to alert physicians of high risk patients requiring a bedside evaluation and assessment, studies have demonstrated that PEWS systems can decrease pediatric intensive care (PICU) utilization, in-hospital cardiac arrests, and overall decreased mortality in high income settings. Yet, many hospital based settings in low and lower middle income countries (LMIC) lack systems in place for early identification of patients at risk for clinical deterioration.MethodsA contextually adapted 16-h pediatric resuscitation program included training of a PEWS tool followed by implementation and integration of a PEWS system in a pediatric hematology/oncology ward in Beit Jala, Palestine. Four PDSA cycles were implemented post-implementation to improve uptake and scoring of PEWS which included PEWS tool integration into an existing electronic medical record (EMR), escalation algorithm and job aid implementation, data audits and ward feedback.ResultsFrequency of complete PEWS vital sign documentation reached a mean of 89.9%. The frequency and accuracy of PEWS scores steadily increased during the post-implementation period, consistently above 89% in both categories starting from data audit four and continuing thereafter. Accuracy of PEWS scoring was unable to be assessed during week 1 and 2 of data audits due to challenges with PEWS integration into the existing EMR (PDSA cycle 1) which were resolved by the 3rd week of data auditing (PDSA cycle 2).ConclusionsImplementation of a PEWS scoring tool in an LMIC pediatric oncology inpatient unit is feasible and can improve frequency of vital sign collection and generate accurate PEWS scores.Contribution to the literatureThis study demonstrates how to effectively implement a PEWS scoring tool into an LMIC clinical setting.This study demonstrates how to utilize a robust feedback mechanism to ensure a quality program uptake.This study demonstrates an effective international partnership model that other institutions may utilize for implementation science.

The effectiveness of EMR implementation regarding reducing documentation errors and waiting time for patients in outpatient clinics: a systematic review

Background: Electronic medical records (EMRs) refer to the digital copies of paper notes prepared in the physician’s office, outpatient clinics and other departments in health care institutes. EMRs are considered to be significant and preferable to paper records because they allow providers to keep accurate track of patient data and monitoring over time, thus reducing errors, and enhance overall health care quality. The aim of this systematic review was to highlight the significance of EMRs and the effectiveness of implementation regarding reducing documentation errors and waiting time for patients in outpatient clinics. Methods: PubMed, Central, Ovid, Scopus, Science Direct, Elsevier, Cochrane , WHO website and the McMaster University Health Evidence website from 2005-2020 were searched to identify studies that investigated the association between the EMR implementation and documentation error and waiting time for patients. A reviewer screened identified citations and extracted data according to the PRISMA guidelines and data was synthesized in a narrative manner. Results: After full text examination of the articles selected for this literature review, the major themes of relevance that were identified in the context of reducing documentation errors and waiting time for patients in outpatient clinic include: reduction of medical errors because of fewer documentation errors resulting from EMR implementation and reduction of waiting time for patients due to overall improvement of system workflow after use of EMRs. Conclusion: In summary of the reviewed evidence from published material, the implementation of an EMR system in any outpatient setting appears to reduce documentation errors (medication dose errors, issues of prescription errors). It was also seen that in many settings, waiting time for patients in outpatient clinics was reduced with EMR use, while in other settings it was not possible to determine if any significant improvement was seen in this aspect after EMR implementation.

The Case of Organizational Innovation Capability and Health Information Technology Implementation Success As You Sow, So You Reap?

Organizational innovation capability is defined as the ability to continuously transform knowledge and ideas into new products, processes and systems for the benefit of an organization and its stakeholders. This study examines the relationship between the innovation capability of healthcare organizations and their ability to successfully implement electronic medical records (EMR), a health information technology (HIT) innovation. Data was collected using a cross-sectional survey and structural equation modeling (SEM) method was used to analyze the data. Results demonstrate that organizational product innovation capability positively affects EMR implementation success. A positive relationship also exists between organizational process innovation capability and EMR implementation success. This study is one of the first to empirically validate the relationship between healthcare organization’s innovation capability and HIT innovation implementation success, in the context of EMRs. Implications of the study for the academic and industry practitioner are discussed.

IMPLEMENTASI DIGITALISASI REKAM MEDIS UNTUK MENDUKUNG REKAM MEDIS ELEKTRONIK

The development of the digital era has highlighted the importance of integrating routine and high-quality data as part of the digital transformation process. One crucial data component that needs to be maintained is the Electronic Medical Record (EMR). Puskesmas Baloi Permai is currently piloting the implementation of EMR and requires technical assistance in digitizing paper-based medical records into electronic form. Digitization is necessary to ensure the continuity of patients' medical history information. This effort aims to support the successful implementation of EMR at Puskesmas Baloi Permai. Solutions are implemented to address the partner's challenges through training and the transfer of knowledge and technology. Training activities involve counseling and demonstrations. The knowledge and technology transfer in Puskesmas Baloi Permai entails introducing new methods and technologies for digitizing medical records and replacing outdated practices. The activities are divided into two stages: initially, a presentation is given on the procedures for digitizing electronic medical records, followed by discussions on the digitization process. To ensure the success of medical record digitization, demonstrations are conducted, including sorting the medical record forms to be scanned, simulating the scanning process, saving files for easy identification, and importing image files into the EMR system through appropriate media.

Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review.

BackgroundThe success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field.ObjectiveWe intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes.MethodsThe scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.ResultsThis review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs.ConclusionsThe body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.

ANALISIS KESIAPAN PENERAPAN REKAM MEDIS ELEKTRONIK (RME)DI RSUP DR. M. DJAMIL PADANG

Introduction: The use of Electronic Medical Records (EMR) can provide great benefits for health services such as basic service facilities and referrals (hospitals). Currently, RSUP dr. M. Djamil plans to implement services with electronic medical records for services efficiency and improve the quality of services provided for patients, and ensure patient safety. Therefore, it is necessary to conduct a readiness assessment before implementing EMR. This will help identify processes and priority scales, as well as help establish operational functions to support the optimization of EMR implementation. Research objectives to analyze the readiness of implementing electronic medical records at RSUP dr. M. Djamil Padang. Methods: The research design used in this research is a case study with a qualitative approach. The research was conducted at the RSUP dr. M. Djamil Padang. The research activity was started from August to October 2020. The informants in this study were selected based on the purposive sampling method. Results: This study shows that organizational culture readiness is quite ready. Knowledge related to the application of EMR has been disseminated to all medical staff and medical support and experience in implementing EMR in the Emergency Room, which was currently running, there were still obstacles, still use manual printouts at the end. Regarding the readiness of governance and leadership, RSUP dr. M. Djamil Padang has a clear vision in implementing EMR. The average informant is optimistic that the change in the manual to electronic medical record system (EMR) can be successfully implemented in RSUP dr. M. Djamil Padang because the EMR can provide benefits for the hospital. The readiness of human resources for medical support is still in a gradual process. For infrastructure readiness, hardware and software can be implemented at RSUP dr. M. Djamil Padang in implementing EMR, although there were still some obstacles, the hospital is optimistic that the implementation of this EMR will run well. Conclusion: EMR implementation readiness still needs to be improved, such as organizational culture readiness, governance and leadership readiness, Human Resources (HR) readiness, and infrastructure readiness.

Decreased in-hospital mortality rate following implementation of a comprehensive electronic medical record system.

To evaluate changes in in-hospital mortality rate following implementation of a comprehensive electronic medical record (EMR) system. Before and after study of 355,709 hospital discharges, over an 8-year period, at a paediatric teaching hospital. The major outcome measures were crude number of in-hospital deaths, deaths per 1000 discharges, and standardised mortality ratio. Primary analysis of data from 2 years before and 2 years after EMR go-live showed a reduction in absolute mortality of 33 deaths, a reduction in the mortality rate of 0.48 per 1000 discharges (95% CI 0.09, 0.88 per 1000): and a relative 22% decrease (95% CI: 4%, 36%, P= 0.02) in deaths per 1000 discharges from 2.20 to 1.72. There was also a reduction in standardised mortality ratio of 47% (95% CI: 18%, 66%, P= 0.004). Post-hoc analysis of mortality rates for an additional 2-year pre-intervention period indicated that these changes in the mortality rate were not part of a pre-existing downward trend. Further analysis of an additional 20-month post-intervention period suggests that the reduced mortality rate has been sustained. We documented evidence of a clinically important decrease in in-hospital mortality rate following the implementation of a modern comprehensive EMR system in an Australian paediatric teaching hospital. The study does not prove a causal relationship, and it is possible that other factors explain some, or all, of this difference, but no changes in the hospital population or other major interventions were identified as alternative explanations for this observed change.

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review

BackgroundElectronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR.ObjectiveThis study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature.MethodsPubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies.ResultsThis systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification.ConclusionThe most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

A High-Fidelity Model to Predict Length of Stay in the Neonatal Intensive Care Unit

Having an interpretable dynamic length-of-stay (LOS) model can help hospital administrators and clinicians make better decisions and improve the quality of care. The widespread implementation of electronic medical record (EMR) systems has enabled hospitals to collect massive amounts of health data. However, how to integrate this deluge of data into healthcare operations remains unclear. We propose a framework grounded in established clinical knowledge to model patients' lengths-of-stay. In particular, we impose expert knowledge when grouping raw clinical data into medically meaningful variables, which summarize patients' health trajectories. We use dynamic predictive models to output patients' remaining lengths-of-stay (RLOS), future discharges, and census probability distributions based on their health trajectories up to the current stay. Evaluated with large-scale EMR data, the dynamic model significantly improves predictive power over the performance of any model in previous literature and remains medically interpretable.

Participatory Design of an Electronic Medical Record for Paediatric Palliative Care: A Think-Aloud Study with Nurses and Physicians.

Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.