Department of Family and Community Medicine, University of Toronto, Ontario, Canada.
Can Fam Physician. 2011 Oct;57(10):e390-7.
To apply the diffusion-of-innovations theory to the examination of factors that are perceived by family physicians as influencing the implementation of electronic medical records (EMRs).
Qualitative study with 2 focus groups 18 months after EMR implementation; participants also took part in a concurrent quantitative study examining EMR implementation and preventive services.
Toronto, Ont.
Twelve community-based family physicians.
We employed a semistructured interview guide. The interviews were audiotaped and transcribed verbatim; 2 researchers independently categorized and coded the transcripts and then met to compare and contrast their findings, category mapping, and interpretations. Findings were then mapped to an existing theoretical framework.
Multiple barriers to EMR implementation were described. These included lack of relative advantage for many processes, high complexity of the system, low compatibility with physician needs and past experiences, difficulty with adaptation of the EMR to the organization and adaptation of the organization to the EMR, and lack of organizational slack. Positive factors were the presence of a champion and relative advantages for some processes.
Early EMR implementation experience is consistent with theoretical concepts associated with implementation of innovations. A problematic implementation process helps to explain, at least in part, the lack of improvement in preventive services in our quantitative results.
运用创新扩散理论来考察家庭医生认为影响电子病历（EMR）实施的因素。
EMR 实施 18 个月后进行的定性研究，有 2 个焦点小组；参与者还同时参与了一项考察 EMR 实施和预防服务的定量研究。
安大略省多伦多市。
12 名社区为基础的家庭医生。
我们采用半结构化访谈指南。对访谈进行录音并逐字转录；2 名研究人员独立对记录进行分类和编码，然后开会比较和对比他们的发现、类别映射和解释。研究结果随后被映射到现有的理论框架中。
描述了多种阻碍 EMR 实施的因素。这些因素包括许多流程缺乏相对优势、系统复杂性高、与医生需求和以往经验不兼容、EMR 难以适应组织以及组织难以适应 EMR、缺乏组织资源。积极因素是存在拥护者和一些流程的相对优势。
早期 EMR 实施经验与与创新实施相关的理论概念一致。有问题的实施过程至少部分解释了我们定量结果中预防服务没有改善的情况。
