Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries

LUDWICK, D; DOUCETTE, J

doi:10.1016/j.ijmedinf.2008.06.005

Cited by 668Electronic Health Records SystemsInformation Systems Theories and ImplementationERP Systems Implementation and Impact

Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries

LUDWICK, D, DOUCETTE, J·2009·International Journal of Medical Informatics

DOI 10.1016/j.ijmedinf.2008.06.005

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Abstract

The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria. Articles show that systems' graphical user interface design quality, feature functionality, project management, procurement and users' previous experience affect implementation outcomes. Implementers had concerns about factors such as privacy, patient safety, provider/patient relations, staff anxiety, time factors, quality of care, finances, efficiency, and liability. The review showed that implementers can insulate the project from such concerns by establishing strong leadership, using project management techniques, establishing standards and training their staff to ensure such risks do not compromise implementation success. The review revealed the concept of socio-technical factors, or "fit" factors, that complicate health information systems deployment. The socio-technical perspective considers how the technical features of a health information system interact with the social features of a health care work environment. The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation. The fact that no articles were found reviewing the benefits or drawbacks of health information systems accruing to patients should be concern to adopters, payers and jurisdictions. No studies were found that compared how provider-patient interactions in interviews are effected when providers used electronic health information systems as opposed to the paper equivalent. Very little information was available about privacy and liability.

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A team-based partnership approach, collaborative efforts and good coordination between stakeholders and organisations were important for implementation.
“A team-based partnership approach, collaborative efforts and good coordination between stakeholders and organisations were all shown to be important for implementation [34, 41, 55, 77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Non-clinical staff often had better knowledge of optimising processes compared to clinicians.
“Non-clinical staff often had better knowledge of optimising processes compared to clinicians [77]”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Different members of the workforce brought different perspectives and skills to the implementation.
“different members of the workforce brought different perspectives and skills to the implementation [77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Patient values and preferences and concerns about clinician-patient relationships impeded implementation.
“patient values and preferences [3, 33] and concerns about clinician-patient relationships [42, 77] impeded implementation”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention, or belief that the intervention was not part of their role were commonly described as a barrier to implementation.
“Resistance to change caused by disagreement with the evidence, negative beliefs about the usefulness or added value of the intervention or belief that the intervention was not part of their role were commonly described as a barrier to implementation [3, 14, 35, 41, 67–70, 76, 77, 80].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]

Previous personal experience in clinical practice or with the information system affected professional attitudes to a new system or intervention.
“Previous personal experience in clinical practice or with the information system affected professional attitudes to a new system or intervention [54, 66, 77, 81].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Effective project management, such as using an incremental approach over time according to a strategic plan allowing a transition period, was shown to facilitate implementation.
“Effective project management (e.g. using an incremental approach over time according to a strategic plan allowing a transition period between old and new system) was shown to facilitate implementation [77].”
From Achieving change in primary care—causes of the evidence to practice gap: systematic reviews of reviews (2015) · cites this paper as [77]
Incentives by government organisations and other external stakeholders may facilitate adoption of e-health by healthcare organisations.
“Incentives by government organisations and other external stakeholders may facilitate adoption by healthcare organisations [17, 18, 39, 48, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
Financial incentives for e-health adoption include initial funds to cover upfront costs, financial sponsorship, reimbursements for adoption, and pay-for-performance initiatives.
“Financial incentives include the provision of initial funds to cover upfront costs [49], financial sponsorship [39], reimbursements for adoption [19, 30, 31, 36], and pay-for-performance initiatives [24, 36, 37, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
Providing a period of transition in which end users can become familiar with and learn how to use new systems has been advocated.
“Providing a period of transition in which end users can become familiar with and learn how to use new systems has been advocated [39, 50].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
Incremental implementation strategies where features are made available to users according to a plan were cited as preferable to 'big bang' approaches to implementation within complex organisations.
“Incremental implementation strategies where features are made available to users according to a plan were cited as preferable to ‘big bang’ approaches to implementation within complex organisations [39, 49].”
From Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update) (2016) · cites this paper as [39]
The challenge of implementing effective decision support for prescribing, and specifically alert fatigue, is international.
“Our study was UK-based, although the challenge of implementing effective decision support for prescribing, and specifically the problem of alert fatigue, is international.12 24 50”
From ‘Too much, too late’: mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing (2013) · cites this paper as [50]
Difficulties in eHealth implementation are international phenomena, with similar problems being widely reported.
“Difficulties in eHealth implementation are international phenomena, with similar problems being widely reported [102-105].”
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A literature review for large-scale health information system project planning, implementation and evaluation
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Blockchain’s coming to hospital to digitalize healthcare services: Designing a distributed electronic health record ecosystem
Cerchione, R., Centobelli, P., Riccio, E., Abbate, S., & Oropallo, E. (2022) · Technovation · doi:10.1016/j.technovation.2022.102480 · Cited by 255 · see citing works
Investigating factors influencing the adoption of e-Health in developing countries: A patient’s perspective
Hoque, M. R., Bao, Y., & Sorwar, G. (2016) · Informatics for Health and Social Care · doi:10.3109/17538157.2015.1075541 · Cited by 240 · see citing works
“…system management; and to improve our health care system ” (1). e-Health initiatives have been widely viewed as an opportunity for a fundamental improvement in the public health care sector to mitigate the enormous demand and supply of health care in both developed and developing nations (2 – 3).”
Background
UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER
Denaxas, S., González-Izquierdo, A., Direk, K., Fitzpatrick, N. K., Fatemifar, G., Banerjee, A., Dobson, R., Howe, L. J., Kuan, V., Lumbers, R. T., et al. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz105 · Cited by 227 · see citing works
“and other researchers for decades.(2) Furthermore, these national EHR data sources are being linked with large-scale consented genomic resources, for example, the 100 000 Genomes Project (also known as Genomics England)(3) and UK Biobank, and enable the investigation of simple or complex traits across participant popu…”
Background
Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress
Murray, E. (2012) · Medicine 2.0 · doi:10.2196/med20.1741 · Cited by 219 · see citing works
“Difficulties in eHealth implementation are international phenomena, with similar problems being widely reported [102-105].”
Background
Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review
Kruse, C. S., & Beane, A. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.8793 · Cited by 188 · see citing works
“Most studies that we found after our initial interest demonstrated a positive relationship between the use of HIT and medical outcomes, and these studies spanned seven countries [6-12].”
Result
The iron cage exposed: Institutional pressures and heterogeneity across the healthcare supply chain
Bhakoo, V., & Choi, T. Y. (2013) · Journal of Operations Management · doi:10.1016/j.jom.2013.07.016 · Cited by 187 · see citing works
Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: Approach, results, and success factors
Bossen, C., Jensen, L. G., & Udsen, F. W. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2013.05.010 · Cited by 185 · see citing works
“However, earlier studies have shown that successful implementation of EHRs also depends on a wide range of contextual and organizational factors [13,16,51], and hence the positive evaluation results merit further discussion.”
Background
Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting
Bloomrosen, M., Starren, J. B., Lorenzi, N. M., Ash, J. S., Patel, V. L., & Shortliffe, E. H. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2010.007567 · Cited by 181 · see citing works
“A systematic literature review outlined lessons learned from HIT implementations in seven countries and found that strong project leadership using appropriate project management techniques, the establishment of standards, and staff training are needed to avoid risks that could compromise success. The review described…”
Background
Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review
Erku, D., Khatri, R. B., Endalamaw, A., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20196854 · Cited by 200 · see citing works
“Factors facilitating the successful implementation of EHRs in PHC settings include improved ICT infrastructure, PHC provider’s motivation and incentives to use them, perceived threat to provider autonomy, conﬁdentiality concerns, EHR design quality and functionality [28,29,60].”
Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users
de Veer, A. J. E., Fleuren, M. A. H., Bekkema, N., & Francke, A. L. (2011) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-11-67 · Cited by 180 · see citing works
“However, training and coaching are usually not sufficient when implementing innovations; multifaceted strategies often appear to be more effective [17,25].”
The impact of clinical leadership on health information technology adoption: systematic review
Ingebrigtsen, T., Georgiou, A., Clay-Williams, R., Magrabi, F., Hordern, A., Prgomet, M., Li, J., Westbrook, J., & Braithwaite, J. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.02.005 · Cited by 165 · see citing works
“The proactive behaviours and partnerships with IT professionals that we found associated with successful adoptions are also relevant for dealing with the organisational factors, barriers and facilitators that other reviews have described as important [18–21].”
Background
Using video-based observation research methods in primary care health encounters to evaluate complex interactions
Asan, O., & Montague, E. N. H. (2014) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v21i4.72 · Cited by 158 · see citing works
Factors affecting sustainable adoption of e-health technology in developing countries: an exploratory survey of Nigerian hospitals from the perspective of healthcare professionals
Zayyad, M. A., & Toycan, M. (2018) · PeerJ · doi:10.7717/peerj.4436 · Cited by 146 · see citing works
“…21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 PeerJ reviewing PDF | (2017:10:21368:2:1:NEW 9 Feb 2018) different departments, enhanced administrative system, and easy maintenance of hospital services (Ludwick & Doucette, 2009; Meier, Fitzgerald & Smith, 2013).”
Prediction of hospitalization due to heart diseases by supervised learning methods
Dai, W., Brisimi, T. S., Adams, W. G., Mela, T., Saligrama, V., & Paschalidis, I. C. (2014) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.10.002 · Cited by 143 · see citing works
“[20] D.”
The application of technology acceptance and diffusion of innovation models in healthcare informatics
Ward, R. (2013) · Health Policy and Technology · doi:10.1016/j.hlpt.2013.07.002 · Cited by 126 · see citing works
“Following a literature review Yarborough and Smith found that studies confirmed the appropriateness of TAM amongst physicians but the “perceived ease of use” construct was not fully supported and suggested that in addition to time issues a collaborative organisational culture that emphasises teamwork is needed for suc…”
Background
Systematic review of health data quality management and best practices at community and district levels in LMIC
Ndabarora, E., Chipps, J. A., & Uys, L. R. (2013) · Information Development · doi:10.1177/0266666913477430 · Cited by 122 · see citing works
“To improve utilization of health information, it is believed that the establishment of strong leadership, using project management techniques, establishing standards and training their staff is essential for implementation success (Ludwick and Doucette, 2009) and more work needs to be done to overcome the barriers to…”
BackgroundMethodInfluential
Effects of health information technology on patient outcomes: a systematic review
Brenner, S. K., Kaushal, R., Grinspan, Z. M., Joyce, C. L., Kim, I., Allard, R. J., Delgado, D., & Abramson, E. L. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv138 · Cited by 126 · see citing works
“visits 12 (28) 9 (21) 3 (5) Mortality 10 (23) 7 (17) 3 (5) Thrombosis or Bleed 9 (21) 6 (14) 4 (9) Length of Stay 4 (9) – 4 (9) Infection Rates 4 (9) 1 (2) 3 (5) Myocardial Infarction or Cardiac Events 3 (7) 2 (5) 1 (2) Hemodynamic Instability or ICU transfer 2 (5) 2 (5) – Chronic Disease Exacerbations 2 (5) – 2 (5) F…”
Influential
Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study
Queenan, J. A., Williamson, T. S., Khan, S., Drummond, N., Garies, S., Morkem, R., & Birtwhistle, R. (2016) · CMAJ Open · doi:10.9778/cmajo.20140128 · Cited by 120 · see citing works
Health Big Data Analytics: A Technology Survey
Harerimana, G., Jang, B., Kim, J. W., & Park, H. K. (2018) · IEEE Access · doi:10.1109/access.2018.2878254 · Cited by 119 · see citing works
“Without the assistance of an integrated healthcare solution, physicians might use the traditional EMR or they might use it to a varying degree depending on how conversant the user is [8], [10].”
Information extraction from electronic medical documents: state of the art and future research directions
Landolsi, M. Y., Hlaoua, L., & Romdhane, L. B. (2022) · Knowledge and Information Systems · doi:10.1007/s10115-022-01779-1 · Cited by 125 · see citing works
“Widespread adoption of HIS has contributed to billions of records [90], and they are recognized as valuable resources for large-scale analysis.”
Background
Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review
Wosny, M., Strasser, L. M., & Hastings, J. (2023) · JMIR Human Factors · doi:10.2196/50357 · Cited by 134 · see citing works
“Previous systematic reviews have explored specific aspects of digital tool integration in health care, offering valuable insights into topics such as mobile health, EHRs, and AI-based technologies [44-46].”
Background
Implementation of a nationwide electronic health record (EHR)
Fragidis, L. L., & Chatzoglou, P. (2018) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa-09-2016-0136 · Cited by 113 · see citing works
“…concerning the adoption of electronic medical records in primary care and the lessons learned from health information system (HIS) implementation experience in seven countries (Canada, the USA, Denmark, Sweden, Australia, New Zealand and the UK) was conducted by Ludwick and Doucette (2009).”
Background
Healthcare service evolution towards the Internet of Things: An end-user perspective
Martínez, E., Cegarra‐Navarro, J., García-Pérez, A., & Fait, M. (2018) · Technological Forecasting and Social Change · doi:10.1016/j.techfore.2018.03.025 · Cited by 114 · see citing works
“Unfortunately, the fast pace of developments in the information technology sector, among other factors, has not always allowed for healthcare systems to be fully adopted by their ultimate beneficiary: the patient and their family and carers (Ludwick and Doucette, 2009).”
Background
Assessing the Adoption of e-Health Technology in a Developing Country: An Extension of the UTAUT Model
Gu, D., Khan, S., Khan, S. U., Khan, S. U., Xie, Y., Li, X., & Zhang, G. (2021) · SAGE Open · doi:10.1177/21582440211027565 · Cited by 123 · see citing works
“E-health originality has been broadly regarded as an opportunity for marked improvement in the public health-care sector to soften the plentiful supply and demand of medical treatment in both developed and less-developed nations (Ball & Lillis, 2001; Ludwick & Doucette, 2009).”
Background
Medical Student Documentation in Electronic Health Records: A Collaborative Statement From the Alliance for Clinical Education
Hammoud, M. M., Dalrymple, J. L., Christner, J. G., Stewart, R., Fisher, J., Margo, K. L., Ali, I., Briscoe, G. W., & Pangaro, L. N. (2012) · Teaching and Learning in Medicine · doi:10.1080/10401334.2012.692284 · Cited by 108 · see citing works
“” 24 Therefore, it is important to provide a safe training environment to train on the EHR.”
Background
A Maturity model for hospital information systems
Carvalho, J. V., Rocha, Á., van de Wetering, R., & Abreu, A. J. (2017) · Journal of Business Research · doi:10.1016/j.jbusres.2017.12.012 · Cited by 108 · see citing works
Primary care physicians’ attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework
O'Donnell, A. J., Kaner, E., Shaw, C., & Haighton, C. (2018) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-018-0703-x · Cited by 112 · see citing works
Practical challenges in integrating genomic data into the electronic health record
Kho, A. N., Rasmussen, L. V., Connolly, J. J., Peissig, P. L., Starren, J., Hakonarson, H., & Hayes, M. G. (2013) · Genetics in Medicine · doi:10.1038/gim.2013.131 · Cited by 108 · see citing works
Integration of a nationally procured electronic health record system into user work practices
Cresswell, K. M., Worth, A., & Sheikh, A. (2012) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-12-15 · Cited by 102 · see citing works
“A recurring theme in this literature is that of clinicians finding it difficult to integrate the use of information technology (IT) systems into their work practices and care provision [6-20].”
Predicting Chronic Disease Hospitalizations from Electronic Health Records: An Interpretable Classification Approach
Brisimi, T. S., Xu, T., Wang, T., Dai, W., Adams, W. G., & Paschalidis, I. C. (2018) · Proceedings of the IEEE · doi:10.1109/jproc.2017.2789319 · Cited by 101 · see citing works
“EHRs have found diverse uses [19], e.g., in assisting hospital quality management [20], in detecting adverse drug reactions [21], and in general primary care [22].”
Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment
Ludwick, D. A., & Doucette, J. (2008) · International Journal of Telemedicine and Applications · doi:10.1155/2009/853524 · Cited by 93 · see citing works
“Instead of a training regimen similar to that described in the literature [21], physicians reported that their vendor simply offered one training session of one half to a full day in duration.”
BackgroundInfluentialSelf-citation
The IT productivity paradox in health: A stakeholder's perspective
Lapointe, L., Mignerat, M., & Vedel, I. (2010) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2010.11.004 · Cited by 92 · see citing works
“Moreover, ccording to the literature in information systems and health nformatics, not many HIT implementations have been sucessful [13,20–23].”
Background
Identifying the Roles of Healthcare Leaders in HIT Implementation: A Scoping Review of the Quantitative and Qualitative Evidence
Laukka, E., Huhtakangas, M., Heponiemi, T., & Kanste, O. I. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082865 · Cited by 92 · see citing works
“It is well-known that HIT implementation requires strong leadership [17,18], yet leaders are not always aware of their roles in HIT implementation [18].”
Background
Tying eHealth Tools to Patient Needs: Exploring the Use of eHealth for Community-Dwelling Patients With Complex Chronic Disease and Disability
Gray, C. S., Miller, D., Kuluski, K., & Cott, C. A. (2014) · JMIR Research Protocols · doi:10.2196/resprot.3500 · Cited by 91 · see citing works
“Issues of shifting responsibilities, changing patient-provider interactions and relationships, and privacy concerns identified by participants have been noted in the eHealth literature [36,39,46,47].”
Background
Progress in electronic medical record adoption in Canada.
Chang, F., & Gupta, N. (2015) · PubMed Central · Cited by 91 · see citing works
Sustainability of health information systems: a three-country qualitative study in southern Africa
Moucheraud, C., Schwitters, A. M., Boudreaux, C., Giles, D., Kilmarx, P. H., Ntolo, N., Bangani, Z., Louis, M. E. S., & Bossert, T. J. (2017) · BMC Health Services Research · doi:10.1186/s12913-016-1971-8 · Cited by 91 · see citing works
Influence of managerial control on performance in medical information system projects: The moderating role of organizational environment and team risks
Liu, S., & Wang, L. (2015) · International Journal of Project Management · doi:10.1016/j.ijproman.2015.10.003 · Cited by 83 · see citing works
The impact of eHealth on relationships and trust in primary care: a review of reviews
Ramachandran, M., Brinton, C. G., Wiljer, D., Upshur, R. E. G., & Gray, C. S. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02176-5 · Cited by 92 · see citing works
“…and providers reportedly perceived that remote consultations build trust [129], facilitate strong alliances and quick exchanges over time [129], continuity and consistent access to the same provider [56, 129], individualized and timely support [56], leading to positive working relationships [56].”
BackgroundInfluential
A case study of an EMR system at a large hospital in India: Challenges and strategies for successful adoption
Scholl, J., Syed-Abdul, S., & Ahmed, L. A. (2011) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2011.07.008 · Cited by 83 · see citing works
Development of a tripolar model of technology acceptance: Hospital-based physicians’ perspective on EHR
Beglaryan, M., Petrosyan, V., & Bunker, E. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.02.013 · Cited by 80 · see citing works
“…and solutions) [33, 46]; d) unavailability of facilitating conditions (involvement, training, organizational support, technical and expert support [40-42, 44, 47, 60]); e) lack of legal framework [42, 50, 61]; f) lack of trust between users; and g) lack of trust in electronic communication [61].”
Background
Analyzing the enabling factors for the organizational decision to adopt healthcare information systems
Yang, Z., Kankanhalli, A., Ng, B.-Y., & Lim, J. T. Y. (2013) · Decision Support Systems · doi:10.1016/j.dss.2013.03.002 · Cited by 82 · see citing works
Evaluation of the integrated disease surveillance and response system for infectious diseases control in northern Ghana
Adokiya, M. N., Awoonor‐Williams, J. K., Barau, I. Y., Beiersmann, C., & Mueller, O. (2015) · BMC Public Health · doi:10.1186/s12889-015-1397-y · Cited by 80 · see citing works
“Often there are also reports of organizational inadequacies for effective and efficient implementation of disease surveillance [35].”
Background
An Organizational Culture-Based Theory of Clinical Information Systems Implementation in Hospitals
Montreal, H., Rivard, S., Lapointe, L., Kappos, A., & Montreal, H. (2011) · Journal of the Association for Information Systems · doi:10.17705/1jais.00258 · Cited by 79 · see citing works
“Because CISs directly support the actual practices of clinicians within a hospital, they need to fit work processes (Littlejohns et al., 2003; Aarts et al., 2004; Ludwick & Doucette, 2009).”
Background
Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation
Yen, P., McAlearney, A. S., Sieck, C. J., Hefner, J. L., & Huerta, T. R. (2017) · JMIR Medical Informatics · doi:10.2196/medinform.7476 · Cited by 80 · see citing works
“From that perspective, understanding the adaptiveness, or HIT adaptation in this process, is thus significant in our understanding of HIT implementation success [50].”
Background
Incorporação de Tecnologias de Informação e Comunicação e qualidade na atenção básica em saúde no Brasil
dos Santos, A. D. F., Sobrinho, D. F., Araújo, L. L., Procópio, C. D. S. D., Lopes, É. A. S., Lima, A., dos Reis, C. M. R., de Abreu, D. M. X., Jorge, A. D. O., & Machado, A. T. G. D. M. (2017) · Cadernos de Saúde Pública · doi:10.1590/0102-311x00172815 · Cited by 77 · see citing works
Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting
Lanham, H. J., Leykum, L. K., & McDaniel, R. R. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000263 · Cited by 75 · see citing works
Complementary methods of system usability evaluation: Surveys and observations during software design and development cycles
Horsky, J., McColgan, K., Pang, J. E., Melnikas, A., Linder, J. A., Schnipper, J. L., & Blackford Middleton, A. (2010) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2010.05.010 · Cited by 76 · see citing works
“Among the core predictors of quick adoption and successful implementation are the design quality of the graphical user interface and functionality, along with socio-technical factors [7].”
Background
Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region
Barbarito, F., Pinciroli, F., Mason, J., Marceglia, S. R. F., Mazzola, L., & Bonacina, S. (2012) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2012.01.006 · Cited by 76 · see citing works
Organizational strategies for promoting patient and provider uptake of personal health records
Wells, S., Rozenblum, R., Park, A., Dunn, M., & Bates, D. W. (2015) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-003055 · Cited by 67 · see citing works
“Taking this socio-technical perspective(33) necessitates organizations to understand their processes of care and how people interact with each other, so they can work out how a new system will best fit in.(29) Consistent with this notion, our study Table 3: Advice for successful implementation: quotes from interviewees”
BackgroundInfluential
Adoption factors of electronic health record systems
Spatar, D., Kok, O. M., Basoglu, N., & Daim, T. (2019) · Technology and Society · doi:10.1016/j.techsoc.2019.101144 · Cited by 68 · see citing works
The Role of Cognitive and Learning Theories in Supporting Successful EHR System Implementation Training
McAlearney, A. S., Robbins, J., Kowalczyk, N. K., Chisolm, D. J., & Song, P. H. (2012) · Medical Care Research and Review · doi:10.1177/1077558711436348 · Cited by 73 · see citing works
“In ambulatory settings, many factors contribute to slow EHR adoption rates and low levels of system use (e.g., Bates, 2005; Ford, Menachemi, Peterson, & Huerta, 2009; Lee, Cain, Young, Chockley, & Burstin, 2005; Simon et al., 2007; Ludwick & Doucette, 2009).”
Background
Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum
Jawhari, B., Keenan, L., Zakus, D., Ludwick, D., Isaac, A., Saleh, A., & Hayward, R. S. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.07.015 · Cited by 72 · see citing works
Self-citation
A taxonomy of antecedents to user adoption of health information systems: A synthesis of thirty years of research
Najaftorkaman, M., Ghapanchi, A. H., Talaei‐Khoei, A., & RAY, P. K. (2014) · Journal of the Association for Information Science and Technology · doi:10.1002/asi.23181 · Cited by 71 · see citing works
“…2012; Cotea, 2010; Davidson & Heslinga, 2006; Ford, 2012b; Gans et al., 2005; Hewitt, 2009; Holden, 2011; Jha et al., 2009; Kemper et al., 2006; Ludwick & Doucette, 2009; Miller & Sim, 2004; Pinaire, 2009; Randeree, 2007; Rao et al., 2011; Simon et al., 2007; Singh et al., 2012; Sittig &…”
Influential
Health providers’ communication skills training affects hypertension outcomes
Sany, S. B. T., Peyman, N., Behzhad, F., Esmaily, H., Taghipoor, A., & Ferns, G. A. (2017) · Medical Teacher · doi:10.1080/0142159x.2017.1395002 · Cited by 69 · see citing works
“Further, patients report good communication with their health care providers who have more years of experiences compared to those with limit-experiences (Ludwick and Doucette 2009, Ha and Longnecker 2010).”
Background
Review of Electronic Decision-Support Tools for Diabetes Care: A Viable Option for Low- and Middle-Income Countries?
Ali, M. K., Shah, S., & Tandon, N. (2011) · Journal of Diabetes Science and Technology · doi:10.1177/193229681100500310 · Cited by 67 · see citing works
Anonymization of Longitudinal Electronic Medical Records
Tamersoy, A., Loukides, G., Nergiz, M. E., Saygın, Y., & Malin, B. (2012) · IEEE Transactions on Information Technology in Biomedicine · doi:10.1109/titb.2012.2185850 · Cited by 68 · see citing works
“(EMR) systems [2], [3] and are increasingly repurposed to support clinical research (see, e.”
Background
Ten key considerations for the successful optimization of large-scale health information technology
Cresswell, K. M., Bates, D. W., & Sheikh, A. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw037 · Cited by 67 · see citing works
Current approaches to identify sections within clinical narratives from electronic health records: a systematic review
Pomares, A., Kreuzthaler, M., & Schulz, S. (2019) · BMC Medical Research Methodology · doi:10.1186/s12874-019-0792-y · Cited by 65 · see citing works
Healthcare providers’ readiness for electronic health record adoption: a cross-sectional study during pre-implementation phase
Ngusie, H. S., Kassie, S. Y., Chereka, A. A., & Enyew, E. B. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-07688-x · Cited by 88 · see citing works
Anything but engaged: user involvement in the context of a national electronic health record implementation
Cresswell, K. M., Morrison, Z., Crowe, S., Robertson, A. R. R., & Sheikh, A. (2011) · Journal of Innovation in Health Informatics · doi:10.14236/jhi.v19i4.814 · Cited by 62 · see citing works
Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective
Sidek, Y. H., & Martins, J. T. (2017) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2017.08.007 · Cited by 61 · see citing works
“Similarly to what has been found in [46], Bru-HIMS end-users feared the potential for novel failure modes to occur due to changing working practices.”
BackgroundResult
General practitioners’ perceptions towards the use of digital health services for citizens in primary care: a qualitative interview study
Fagerlund, A. J., Holm, I. M., & Zanaboni, P. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028251 · Cited by 58 · see citing works
“In order to release some of the potential of health informatics systems, it has been argued that, among others, feature functionality, project management and user-related outcomes affect implementation outcomes.(12) The aim of this study was to explore GPs’ perceptions towards the use of digital health services for ci…”
Background
The moderating effects of demographic and individual characteristics on nurses' acceptance of information systems: A canadian study
Ifinedo, P. (2015) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2015.12.012 · Cited by 59 · see citing works
“The diffusion of such technologies in healthcare has expanded dramatically across the world, and is expected to increase in the coming years (Ludwick & Doucette 2009; Lee et al. 2013).”
Factors affecting the mature use of electronic medical records by primary care physicians: a systematic review
Rahal, R. M., Mercer, J. G., Kuziemsky, C. E., & Yaya, S. (2021) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-021-01434-9 · Cited by 61 · see citing works
“However, as highlighted in previous studies [15, 59], the literature in this field may be poorly referenced within bibliographic databases because terminology is not standardized, and there is no taxonomic consensus related to health information technologies [60].”
Background
Assessing E-Health adoption readiness using diffusion of innovation theory and the role mediated by each adopter's category in a Mauritian context
Putteeraj, M., Bhungee, N., Somanah, J., & Moty, N. (2021) · International Health · doi:10.1093/inthealth/ihab035 · Cited by 66 · see citing works
Understanding the perception towards using mHealth applications in practice
Sezgın, E., Özkan, S., & Yıldırım, S. (2016) · Information Development · doi:10.1177/0266666916684180 · Cited by 59 · see citing works
“In parallel, the literature reveals that healthcare technologies may not be as promising as they seem, since factors like users’ previous experiences, risk levels and organizational culture can remarkably affect the attitudes of professionals (Ludwick and Doucette, 2009; Li et al., 2013).”
Background
Adopting electronic medical records: are they just electronic paper records?
Price, M., Singer, A. G., & Kim, J. (2013) · Europe PMC (PubMed Central) · Cited by 57 · see citing works
The Heimdall framework for supporting characterisation of learning health systems
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“Further, user involvement, strong leadership, project management techniques, and standards are important in ensuring successful implementation [3,39,40].”
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“An EMR can be defined as a computerized sys-tem where physicians record relevant information such as patient demographics, medical histories, consultation notes, lists of problems, allergies, vaccinations, vital signs, and prescriptions/renewals [4].”
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“Hearing experiences and addressing needs of a wide range of stakeholders in the process of development and implementation is challenging [15], but it was necessary to achieve this first Brazilian web-based system that meets specific service needs, integrate public mental health care service…”
Background
How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals
Nadav, J., Kaihlanen, A., Kujala, S., Laukka, E., Hilama, P., Koivisto, J., Keskimäki, I., & Heponiemi, T. (2021) · Journal of Medical Internet Research · doi:10.2196/31668 · Cited by 55 · see citing works
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“systems in primary care In a systematic review of factors promoting adoption of health information management systems (IMS), Ludwick &Doucette identified a range of factors which contributed to the outcomes of system implementation: user interface design, system functionalities, system suppliers, change and risk manag…”
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Sociotechnical analysis of nurses’ use of personal mobile phones at work
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Authors: LUDWICK, D., & DOUCETTE, J.
Affiliations: University of Alberta (CA)
ORCID: DOUCETTE, J
Venue: International Journal of Medical Informatics
Publisher: Elsevier BV
Published: 2009-01
Volume: 78
Issue: 1
Pages: 22-31
ISSN: 1386-5056 (ISSN-L)
DOI: 10.1016/j.ijmedinf.2008.06.005
OpenAlex: W2005519248
Cited by: 668
References: 57
Citations by year: 2026: 4 · 2025: 15 · 2024: 21 · 2023: 35 · 2022: 30 · 2021: 38 · 2020: 40 · 2019: 43 · 2018: 55 · 2017: 50 · 2016: 46 · 2015: 56 · 2014: 57 · 2013: 46 · 2012: 41
FWCI: 64.50
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: International Journal of Medical Informatics (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
Social Sciences › Sociology and Political Science › Information Systems Theories and Implementation
Social Sciences › Business, Management and Accounting › Management Information Systems › ERP Systems Implementation and Impact
Keywords: electronic health records, health information systems, primary care, implementation outcomes, user interface design, project management, privacy concerns, patient safety, employee training, implementation barriers, cross-national comparison
MeSH terms: Humans, Medical Informatics, Primary Health Care, Risk Factors, Medical Records Systems, Computerized, Internationality

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Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries

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