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Kaiser Permanente's experience of implementing an electronic medical record : a qualitative study

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scott2005bmj1313.pdf (83.47Kb)
Date
03/12/2005
Author
Scott, James Timothy
Rundall, Thomas G
Vogt, Thomas M
Hsu, John
Keywords
ZA4050 Electronic information resources
R Medicine
Metadata
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Abstract
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 die 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.
Citation
Scott , J T , Rundall , T G , Vogt , T M & Hsu , J 2005 , ' Kaiser Permanente's experience of implementing an electronic medical record : a qualitative study ' , British Medical Journal , vol. 331 , no. 7528 , pp. 1313-1316 . https://doi.org/10.1136/bmj.38638.497477.68
Publication
British Medical Journal
Status
Peer reviewed
DOI
https://doi.org/10.1136/bmj.38638.497477.68
ISSN
0959-8138
Type
Journal article
Rights
© 2005 Scott et al. This is an article distributed in accordance with the terms of the Creative Commons Attribution (CC BY NC 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for noncommercial use, provided the original work is properly cited.
Description
The Commonwealth Fund of New York supported Tim Scott through a Harkness Fellowship. The Garfield Foundation provided funding for the data collection.
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  • University of St Andrews Research
URL
http://www.scopus.com/inward/record.url?scp=28544451981&partnerID=8YFLogxK
http://www.bmj.com/content/331/7528/1313
URI
http://hdl.handle.net/10023/4675

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