Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus.

BACKGROUND The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-naïve public primary care centres in Cyprus. METHODS One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. RESULTS Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. CONCLUSION The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population.

[1]  Lawrence M. Fagan,et al.  Research Paper: The PEN-Ivory Project: Exploring User-interface Design for the Selection of Items from Large Controlled Vocabularies of Medicine , 1996, J. Am. Medical Informatics Assoc..

[2]  F. Girosi,et al.  Promoting health information technology: is there a case for more-aggressive government action? , 2005, Health affairs.

[3]  I. Sim,et al.  Physicians' use of electronic medical records: barriers and solutions. , 2004, Health affairs.

[4]  Marc Verbeke,et al.  The International Classification of Primary Care (ICPC-2): an essential tool in the EPR of the GP , 2006, MIE.

[5]  W H Isbister,et al.  Qualitative research in health care , 2000, BMJ : British Medical Journal.

[6]  P Knaup,et al.  Section 2: Patient Records: Electronic Patient Records and their Benefit for Patient Care , 2006, Yearbook of Medical Informatics.

[7]  I. Okkes,et al.  Advantages of Long Observation in Episode-oriented Electronic Patient Records in Family Practice , 2001, Methods of Information in Medicine.

[8]  Stephen M Shortell,et al.  Drivers of electronic medical record adoption among medical groups. , 2005, Joint Commission journal on quality and patient safety.

[9]  Thomas G Rundall,et al.  Kaiser Permanente's experience of implementing an electronic medical record: a qualitative study , 2005, BMJ : British Medical Journal.

[10]  I. Okkes,et al.  Developing an Appropriate EPR System for the Greek Primary Care Setting , 2003, Journal of Medical Systems.

[11]  Simon de Lusignan,et al.  Moving to paperlessness: a case study from a large general practice. , 2003, Informatics in primary care.

[12]  G. A. Loomis,et al.  If electronic medical records are so great, why aren't family physicians using them? , 2002, The Journal of family practice.

[13]  Sheila Teasdale,et al.  Improving the safety features of general practice computer systems. , 2003, Informatics in primary care.

[14]  Kenneth G Adler.  Why it's time to purchase an electronic health record system. , 2004, Family practice management.

[15]  Qingxia Chen,et al.  An Electronic Medical Record in Primary Care: Impact on Satisfaction, Work Efficiency and Clinic Processes , 2006, AMIA.

[16]  Eric W. Ford,et al.  Predicting the adoption of electronic health records by physicians: when will health care be paperless? , 2006, Journal of the American Medical Informatics Association : JAMIA.

[17]  Michael Bainbridge,et al.  Improving information management in family practice: testing an adult learning model , 1997, AMIA.

[18]  D. McInnes,et al.  General practitioners’ use of computers for prescribing and electronic health records: results from a national survey , 2006, The Medical journal of Australia.

[19]  Amy N. Cohen,et al.  Review paper: Informatics Systems to Promote Improved Care for Chronic Illness: A Literature Review , 2007, J. Am. Medical Informatics Assoc..

[20]  Christian Lovis,et al.  Power of expression in the electronic patient record: structured data or narrative text? , 2000, Int. J. Medical Informatics.

[21]  James G. Anderson,et al.  Social, ethical and legal barriers to E-health , 2007, Int. J. Medical Informatics.

[22]  G E Fryer,et al.  The role of family practice in different health care systems: a comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States. , 2002, The Journal of family practice.

[23]  Torunn Wibe,et al.  Implementation of nursing care plan in the Electronic Patient Record (EPR) findings and experiences. , 2006, Studies in health technology and informatics.