Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study
Open accessAbstract
OBJECTIVE: To examine users' attitudes to implementation of an electronic medical record system in Kaiser Permanente Hawaii. DESIGN: Qualitative study based on semistructured interviews. SETTING: Four primary healthcare teams in four clinics, and four specialty departments in one hospital, on Oahu, Hawaii. Shortly before the interviews, Kaiser Permanente stopped implementation of the initial system in favour of a competing one. PARTICIPANTS: Twenty six senior clinicians, managers, and project team members. RESULTS: Seven key findings emerged: users perceived the decision to adopt the electronic medical record system as flawed; software design problems increased resistance; the system reduced doctors' productivity, especially during initial implementation, which fuelled resistance; the system required clarification of clinical roles and responsibilities, which was traumatic for some individuals; a cooperative culture created trade-offs at varying points in the implementation; no single leadership style was optimal--a participatory, consensus-building style may lead to more effective adoption decisions, whereas decisive leadership could help resolve barriers and resistance during implementation; the process fostered a counter climate of conflict, which was resolved by withdrawal of the initial system. CONCLUSIONS: Implementation involved several critical components, including perceptions of the system selection, early testing, adaptation of the system to the larger organisation, and adaptation of the organisation to the new electronic environment. Throughout, organisational factors such as leadership, culture, and professional ideals played complex roles, each facilitating and hindering implementation at various points. A transient climate of conflict was associated with adoption of the system.
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If patient loads are not decreased temporarily during training periods, clinicians work longer hours to complete their combined electronic and clinical work.
“If their patient loads are not decreased temporarily during training periods, clinicians work longer hours to complete their combined electronic and clinical work.13”
From Types of Unintended Consequences Related to Computerized Provider Order Entry (2006) · cites this paper as [13]
In “Adaptation of the organisation to the new electronic medical record environment” (p. 1314), clinicians report an additional 30–75 minutes of electronic-record work per day, and the implementation provided extra clinicians to help with the initial workload. The paper does not establish the claimed condition that patient loads were not temporarily reduced during training, or that this caused clinicians to work longer hours. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOther qualitative studies of EHR implementations have mainly focused on implementation barriers, system-wide challenges, or overall benefits and concerns rather than patient safety.
“Other qualitative investigations have analyzed EHR implementations, but primarily focused on barriers to implementation, system-wide challenges, or overall benefits and concerns rather than patient safety . 35 -39”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [35]
Health care providers' frustration from software problems can promptly escalate and result in resistance to continue using the system.
“Extensive software testing of the vendor's claims for the baseline functionality and system adaptability to local needs is critical before the implementation, as health care providers' frustration from software problems can promptly escalate and result in resistance to continue using the system [128].”
From Health Care Provider Adoption of eHealth: Systematic Literature Review (2013) · cites this paper as [128]
Health care providers' participatory process is essential to fine-tune the eHealth system's capabilities after thorough workflow analysis.
“After the workflow is analyzed thoroughly with health care providers’ involvement, their participatory process is also essential to fine-tune the system’s capabilities [128].”
From Health Care Provider Adoption of eHealth: Systematic Literature Review (2013) · cites this paper as [128]
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Research works printed but not linked: 2
- Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study. BMJ 2005;331:1313-6.
- Teasdale S. Shaping sands, shifting services [editorial]. Inform Prim Care 2005;13:81-2.
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- Authors
- Scott, J. T., Rundall, T. G., Vogt, T. M., & Hsu, J.
- Affiliations
- University of St Andrews (GB)
- Kaiser Permanente (US)
- Corresponding author
- Scott, J Tim
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2005-11-03
- Volume
- 331
- Issue
- 7528
- Pages
- 1313-1316
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1298854
- OpenAlex
- W2116134825
- Cited by
- 266
- References
- 18
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 6 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 2 · 2019: 11 · 2018: 10 · 2017: 7 · 2016: 12 · 2015: 17 · 2014: 27 · 2013: 20 · 2012: 17
- FWCI
- 28.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- St Andrews Research Repository (St Andrews Research Repository) (submittedVersion, cc-by-nc)
- Funders
- Commonwealth Fund
- 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 technology implementation, Kaiser Permanente, user attitudes, implementation resistance, software design, clinician productivity, leadership styles, organizational culture, system selection, primary care, hospital departments
- MeSH terms
- Attitude of Health Personnel, Attitude to Computers, Hawaii, Humans, Leadership, Medical Staff, Hospital, Organizational Culture, Medical Records Systems, Computerized
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