Use Of Electronic Medical Record Systems Research Articles

The impact of office-related metrics on meeting physician expectations from Electronic Medical Record systems

Meeting expectations is a proxy for satisfaction. With the widely used Electronic Medical Record (EMR) systems, the focus should be on whether they meet the expectations of healthcare workers and physicians. Data from a quantitative survey amongst physicians, not practices, on adopting EMR systems are analyzed with Structural Equation Modeling (SEM), K-means (K = 2) cluster analysis, and Binary Logistic Regression. The goal is to understand what factors influence meeting expectations and if these parameters are sufficient to predict the physicians’ positive or negative experiences. A path diagram shows that office-related metrics (staff skills, training, and the system’s ease of use) are the largest determinant of meeting expectations as experienced by the physicians. Two clusters centered around opposite negative and positive answers from physicians on the quality of the systems were found. The clusters provide a considerable increase in accuracy compared with the baseline in classifying positive against negative responses on meeting expectations. Physicians value the impact of EMR systems on the practice and personnel more than their own experience. We conclude medical practices should be aware of the difficulties their staff may face before implementing and during the use of EMR systems.

Retention and Predictors of Attrition Among HIV-infected Children on Antiretroviral Therapy in Côte d'Ivoire Between 2012 and 2016.

An estimated 21,000 children 0-14 years of age were living with HIV in Côte d'Ivoire in 2020, of whom only 49% have been diagnosed and are receiving antiretroviral therapy (ART). Retention in HIV care and treatment is key to optimize clinical outcomes. We evaluated pediatric retention in select care and treatment centers (CTCs) in Côte d'Ivoire. We retrospectively reviewed medical records using 2-stage cluster sampling for children under 15 years initiated on ART between 2012 and 2016. Kaplan-Meier time-to-event analysis was done to estimate cumulative attrition rates per total person-years of observation. Cox proportional hazard regression was performed to identify factors associated with attrition. A total of 1198 patient records from 33 CTCs were reviewed. Retention at 12, 24, 36, 48 and 60 months after ART initiation was 91%, 84%, 74%, 72% and 70%, respectively. A total of 309 attrition events occurred over 3169 person-years of follow-up [266 children were lost to follow-up (LTFU), 29 transferred to another facility and 14 died]. LTFU determinants included attending a "public-private" CTC [adjusted hazard ratio (aHR) 6.05; 95% confidence interval (CI): 4.23-8.65], receiving care at a CTC without an on-site laboratory (aHR: 4.01; 95% CI: 1.70-9.46) or attending a CTC without an electronic medical record (EMR) system (aHR: 2.22; 95% CI: 1.59-3.12). In Cote d'Ivoire, patients attending a CTC that is public-private, does not have on-site laboratory or EMR system were likely to be LTFU. Decentralization of laboratory services and scaling use of EMR systems could help to improve pediatric retention.

Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis

The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals.

Quantifying Emergency Physician Interruptions due to Electrocardiogram Review.

Interruptions are recognized as potentially harmful to safety and efficiency, and are especially prevalent in the emergency department (ED) setting. Policies urging immediate review of all electrocardiograms (ECGs) may lead to numerous and frequent interruptions. We assessed the role of ECG review as a source of ED interruptions to characterize a potential target for interventions. We analyzed emergency physician time use during the course of a clinical shift using a time-and-motion design. A research assistant observed a convenience sample of shifts, observing and logging transitions between different tasks using an electronic device. Instances of ECG review were tallied, with start and ending times of ECG review recorded to the nearest second. An ECG review was considered an interruption if the immediate prior and subsequent tasks were the same. Twenty shifts were observed for a total of 149h. There were 211 ECG reviews, (mean rate 1.4 per hour), with more frequent review among physicians staffing a zone with higher-acuity patients (2.8 per hour), where clustering of multiple ECG reviews in succession was more common. Seventy-five percent of ECG reviews required < 30s. Of all 211 ECG reviews, 102 (48%) were an interruption. The tasks most frequently interrupted were electronic medical record system use (68 of 102, 67%) and communicating with ED staff in person (18 of 102, 18%). Review of ECGs was a substantial driver of interruptions for emergency physicians. Interventions to integrate ECG review more naturally into physician workflow may improve patient safety by reducing these interruptions.

Enabling Laboratory Medicine in Primary Care Through IT Systems Use

Important problems remain regarding the efficiency and quality of laboratory testing in primary care. In view of this, a significant function of electronic medical record (EMR) systems is to enable the practice of laboratory medicine by primary care physicians. The present study aims to deepen our understanding of the nature and extent of physicians' use of EMR and other laboratory information exchange systems for patient management and care within the laboratory testing process. We conducted a survey of 684 Canadian family physicians. Results indicate that physicians use 84 percent of the laboratory functionalities available in their EMR system. The two most important impacts are the ability to gain time in the post-analytical phase and to take faster action in this same phase as they follow-up on their patients' test results. Physicians who perceive to benefit most from their EMR use are those who make the most extensive use of their system. Extended use of an EMR system allows primary care physicians to better ascertain and monitor the health status of their patients, verify their diagnosis assumptions, and, if their system includes a clinical decision support module, apply evidence-based practices in laboratory medicine.

Primary Care Physicians' Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study.

BackgroundChronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features.ObjectiveThis study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured.MethodsGuided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF.ResultsA total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership.ConclusionsThe CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM.

Information processing in electronic medical records: A survey validation

The purpose of this study was to validate the Clinical Information Processing Instrument. This instrument attempts to examine information processing in electronic medical records (EMRs). We drew upon the theory of swift and even flow to guide survey development and construction. We used a mixed-methods approach to gather data from registered nurses. Nurses were invited to participate in focus groups, an expert panel, and the survey validation process. A semi-structured questionnaire addressed the following themes: method of communication, quality of information, and usability of the system. We conducted a confirmatory factor analysis using structural equation modelling. The Kaiser-Meyer-Olkin measure was greater than 0.7 (0.90), and the Bartlett's test of sphericity was significant (X2 =1519.03, df=105, P<0.001). The proposed structural equation model was analysed and revised to a final model that was statistically significant. The final survey, Clinical Information Processing Instrument, contained 18 Likert scale questions that supported the tenets of the theory of swift and even flow. The nurses perceived EMRs as efficient for medication management, time management, and communication. The Clinical Information Processing Instrument is a validated survey tool that assesses information flow in EMRs. The Clinical Information Processing Instrument was validated as an approach to analyse the utility of EMR in disseminating information among clinical staff. To increase the utility and meaningful use of EMR systems, it is important to consider factors that affect the distribution of information among clinicians.

Impact of electronic medical records (EMRs) on hospital productivity in Japan

IntroductionConsistent with the global trend, Japanese hospitals have increasingly adopted electronic medical record (EMR) systems in the last 20 years. Although improved productivity is emphasized as one of the benefits of information technology (IT), there is a paucity of data regarding how the use of EMR systems influences the productivity of Japanese hospitals. MethodsThis retrospective study focused on 658 municipal hospitals. The study period was from 2006 to 2015. We analyzed the labor productivity and multi-factor productivity (MFP) of the hospitals and their average rate of change during the study period. Logistic regression models were used to assess how EMR implementation influenced labor productivity and MFP growth. We considered the duration of EMR operation, and hospitals using EMRs were divided into three groups based on tertiles of time elapsed since the implementation of the EMR system: “early adopters”, “followers”, and “late adopters”. ResultsWe found that the implementation of an EMR system had a significantly negative impact on MFP growth for the ‘late adopters’ (OR 0.51; 95%CI 0.31–0.82; p = 0.006). No significant association was found between EMR implementation and labor productivity growth. ConclusionEMR implementation has an adverse effect on the productivity of municipal hospitals in Japan. This finding should be considered when developing future healthcare policies promoting the implementation of IT.

Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada

ObjectiveIn the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DesignPopulation-based, cross-sectional study. ParticipantsA total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). MethodsData regarding speciality surgeons’ adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. ResultsCompared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: “no suitable product for my practice” (p = 0.01), “too costly” (p = 0.0006), “too time consuming” (p < 0.0001), and “planning to retire soon” (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. ConclusionsThe barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.

A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment.

In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed.

The effect of electronic medical record system use on communication between pharmacists and prescribers.

BackgroundThe Electronic Medical Record (EMR) is becoming increasingly common in health care settings. Research shows that EMRs have the potential to reduce instances of medication errors and improve communication between pharmacists and prescribers; however, more research is required to demonstrate whether this is true. This study aims to determine the effect of a newly implemented EMR system on communication between pharmacists and primary care clinicians.MethodsA retrospective chart analysis of primary care EMR data comparing faxed pharmacy communications captured before and after the implementation of an EMR system at an academic family medicine clinic. Communication requests were classified into the following various categories: refill accepted, refill denied, clarification, incorrect dose, interaction, drug insurance/coverage application, new prescription request, supplies request, continued care information, duplicate fax substitution, opioid early release request, confirmation by phone call, and other.ResultsThe number and percentage of clarification requests, interaction notifications, and incorrect dose notifications were lower after the implementation of the EMR system. The number and percentage of refills accepted and new prescription requests increased after the implementation of the EMR system.ConclusionThe implementation of an EMR in an academic family medicine clinic had a significant effect on the volume of communication between pharmacists and prescribers. The amount of clarification requests and incorrect dosing communications decreased after EMR implementation. This suggests that EMRs improve prescribing safety. The increased amount of refills accepted and new prescription requests post EMR implementation suggests that the EMR is capable of changing prescription patterns.

The Attitude towards and Use of Electronic Medical Record System by Health Professionals at a Referral Hospital in Northern Ethiopia: Cross-Sectional Study

Background and Purpose: Electronic medical record (EMR) systems are increasingly incorporated into the healthcare systems of developing countries to improve the effectiveness and efficiency of the healthcare institutions. Inaccuracy, non-timeliness, incompleteness and inconsistency of paper-based data are basic triggering points to adopt EMRs in developing countries. The purpose of this study was to assess the attitude, use, and hindering factors of health professionals’ use of EMR in one referral hospital in Ethiopia that has used the EMR for the last two years. Methods: An institutional based cross-sectional quantitative study was conducted in March 2014 among 501 health professionals. Self-administered questionnaire was used to collect data. Data were entered and analysed using Epi-Info version 7 and SPSS version 20 respectively. Descriptive statistics were computed to describe study variables. Bivariate and multivariate logistic regression analyses were used to show the presence of association between the study and outcome variables. Odds ratio at 95% confidence level was used to describe the strength of association. Results: A total of 428 health professionals participated in the study with a response rate of 86%. The majority, 318 (74.3%) were computer literate and more than half, 246 (57.5%) of them had computer access. A large number (71.0%) of respondents used EMR and more than half (56.1%) had a good attitude towards it. Health professionals’ age, computer literacy, computer assess, working experience, regular meeting and training on the EMR system were significant factors (p-value <0.05) to the attitude and use of EMR system. Educational level, knowledge on EMR and using EMR were also variables affecting users’ attitude towards EMR. Conclusions: Majority of the respondents used the EMR system in their daily works and more than half of them had a good attitude towards EMR. Technical (computer literacy, knowledge), organizational (computer access, infrastructure, training access, regular meeting, management support), and personal (age, working experience) variables are significant factors to develop a good attitude towards and high use of the system. Improving skills, awareness, infrastructure, management and resource allocation are important interventions to improve the EMR system performance and positive attitude towards health professionals in the study area. Keywords: Electronic Medical Record, Ethiopia, Attitude.

Comprehensive evaluation of electronic medical record system use and user satisfaction at five low-resource setting hospitals in ethiopia.

BackgroundElectronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings.ObjectiveThe objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice.MethodsA quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors.ResultsHealth professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01).ConclusionsHealth professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock.

TimmyCare: an electronic medical record for resource-poor environments

Abstract Background Research of electronic medical records (EMR) shows the minimum use of EMR systems by medical service providers in the developing world. Insufficient EMRs restrict the ability of service providers to manage patients' conditions, track patients' outcomes, and use or share data. Methods To improve the quality of medical service provision, enhance data collection, and enable data-driven decision-making, Timmy Global Health created TimmyCare. Complete with an intuitive, web-based, localised user-interface, mainly customisable data gathering platform, cloud-based and encrypted data storage, and minimum hardware and technical requirements, TimmyCare can bring EMR technology to challenging areas of the developing world. TimmyCare has been tested in a variety of developing world environments, including in mobile clinics in the Amazon basin, locally run primary-care medical clinics in Ecuador and Guatemala, and in a rural health-care programme focused on migrants close to the border of Haiti and the Dominican Republic Findings TimmyCare has improved service provision for roughly 14 000 patients from developing countries. The services has improved Timmy Global Health's ability to monitor patients' conditions, by provision of accessible patient histories; decreased patients' waiting time in Timmy Global Health's medical clinics (in some instances from 3 h to 1 h); and improved patients' follow-up by easy identification of patients with chronic or complex conditions. TimmyCare also enables collection and analysis of population health measurements, thus improving Timmy Global Health's ability to tailor service provision in response to data-backed trends. Interpretation In view of TimmyCare's scalable, customisable, intuitive design, and the potential size of the need for EMR's in the developing world, TimmyCare could enhance service provision in a cost-effective and administratively efficient manner. Funding Timmy Global Health.

Commentary: The RIME/EMR Scheme: An Educational Approach to Clinical Documentation in Electronic Medical Records

Electronic medical records (EMRs) increasingly are used to document the delivery of patient care. Clinical practices that are involved in medical education are more likely to employ EMRs. Yet, the growing use of EMRs presents a new set of challenges for undergraduate and graduate medical education. EMRs can significantly impact how trainees learn and develop medical decision-making strategies and clinical documentation skills. EMRs also affect how clinical notes are evaluated and how feedback is provided to the learner. To use EMRs effectively, students must learn how narrative elements (how to take and record a medical history and physician examination), data elements (laboratory, radiology, medication, and information from ancillary and consultative services), and system elements (how EMRs function within the context of the health care or hospital system where the student trains) combine in the context of compassionate, competent, and safe patient care. This commentary specifically addresses educational issues surrounding student and resident use of EMR systems. The Reporter-Interpreter-Manager-Educator scheme is one approach to teach and evaluate clinical documentation skills using EMRs in the context of the Accreditation Council for Graduate Medical Education core educational competencies.

Use of health information technology in home health and hospice agencies: United States, 2007

This report provides updated estimates on use of electronic medical records (EMRs) in US home health and hospice (HHH) agencies, describes utilization of EMR functionalities, and presents novel data on telemedicine and point of care documentation (PoCD) in this setting. Nationally representative, cross-sectional survey of US HHH agencies conducted in 2007. Data on agency characteristics, current use of EMR systems as well as use of telemedicine and PoCD were collected. In 2007, 43% of US HHH agencies reported use of an EMR system. Patient demographics (40%) and clinical notes (34%) were the most commonly used EMR functions among US HHH agencies. Only 20% of agencies with EMR systems had health information sharing functionality and about half of them used it. Telemedicine was used by 21% of all HHH agencies, with most (87%) of these offering home health services. Among home health agencies using telemedicine, greater than 90% used telephone monitoring and about two-thirds used non-video monitoring. Nearly 29% of HHH agencies reported using electronic PoCD systems, most often for Outcome and Assessment Information Set (OASIS) data capture (79%). Relative to for-profit HHH agencies, non-profit agencies used considerably more EMR (70% vs 28%, p<0.001) and PoCD (63% vs 9%, p<0.001). Between 2000 and 2007, there was a 33% increase in use of EMR among HHH agencies in the US. In 2007, use of EMR and PoCD technologies in non-profit agencies was significantly higher than for-profit ones. Finally, HHH agencies generally tended to use available EMR functionalities, including health information sharing.

Physician Characteristics and EMR Attitudes

Despite the numerous purported benefits of Electronic Medical Records (EMR), the medical profession has been extremely reluctant to embrace the technology. One of the barriers believed to be responsible for the slow adoption of EMR technology is resistance by many physicians who are not convinced of the advantages of using EMR systems. This study examined potential characteristics of physicians that might help identify those individuals that are most likely to pose a threat to the successful implementation of an EMR system in a multi-specialty clinic. The results demonstrated that older physicians and physicians with only minimal computer skills are more likely to have negative attitudes regarding EMR technology. Medical specialists were most likely to have positive attitudes with respects to the use of EMR systems, while primary care physicians were most likely to have doubts regarding the purported benefits of EMR technology.

Electronic Medical Record System in a Headache Specialty Practice: A Patient Satisfaction Survey

Since November 2002, Headache Wellness Center, a specialty headache practice in Greensboro, NC, has used exclusively an electronic medical record (EMR) system for all patient clinical contacts. To assess patient satisfaction and perceptions regarding this new office technology and to better understand the EMR-patient-physician relationship. An EMR satisfaction survey was administered from February to June 2006 and was completed by 394 patients. All patients were known to the practice and completed the survey at the time of a headache revisit evaluation. The majority of respondents believed that EMR system use was not intrusive; did not draw attention away from patient contact; provided more efficient and accurate interactions; and preferred an EMR system in this particular headache setting. Patient satisfaction with an EMR system in a headache specialty practice was high.

Contextual influences on technology use mediation: a comparative analysis of electronic medical record systems

Developing, implementing and assimilating information technologies into organizational practices pose significant technical and social challenges. In this paper, we explore technology use mediation (TUM) processes in two cases of electronic medical record system use in two healthcare organizations. In our analysis, we examine contextual influences on mediation and consider TUM processes and outcomes in projects utilizing modern systems development methods. We found that crucial TUM actions occurred during systems development phases as well as during system use, that mediation was vitally important with these specialized IT artefacts, and that system configuration required changes to software infrastructure and code. Organizational size influenced the availability and the effectiveness of mediation resources; with adequate resources committed to the task, the institutional environment presented substantial, but not insurmountable, challenges to technology use mediation. We consider implications for practice and suggest future research directions.