ENABLING FACTORS FOR ACHIEVING GREATER

SUCCESS IN ELECTRONIC MEDICAL RECORD INITIATIVES

Wilfred Bonney

School of Business and Technology, Capella University, Minneapolis, MN, U.S.A.

Keywords: Electronic medical record, Interoperability, Health data standards, Critical success factors.

Abstract: The introduction of Electronic Medical Record (EMR) systems in the healthcare industry has brought

anticipation as to whether the use of the system is enabling or constraining healthcare providers’ efforts in

providing efficient healthcare services and evidence-based practice. Although few EMR systems have

managed to achieve success in the healthcare industry, many have failed to meet the expectations of

healthcare providers and the general public. In this paper, a literature review was used to explore the

possible trends or factors which may help future electronic medical record initiatives achieve greater

success and less failure. The practical and research implications for implementing successful EMR

initiatives are also discussed.

1 INTRODUCTION

The practice of collecting and storing patient’s

information in computerized medical information

systems, rather than paper charts has increasingly

gained popularity amongst many healthcare

providers (Adler-Milstein and Bates, 2010; Harrison

and Ramanujan, 2011; Hsieh, 2010). In their attempt

to promote awareness about the under-utilization of

Information Technology in the healthcare sector,

Adler-Milstein and Bates (2010) noted that the use

of computerized medical information systems have

the potential to support evidence-based practice and

transform how care is delivered to patients. Adler-

Milstein and Bates (2010) posited that Information

Technology is “increasingly being considered a

natural tool for aiding providers, as computers can

easily store up-to-date information on domains like

medications and their contraindications” (p. 120).

These considerations have accelerated the

development of Electronic Medical Record (EMR)

systems and promoted their continuing use and

adoption in medical practice.

However, the introduction of EMR systems in

the healthcare industry has also brought anticipation

as to whether the use of the system is enabling or

constraining healthcare providers’ efforts in

providing efficient healthcare services and evidence-

based practice. Although few EMR systems have

managed to achieve success in the healthcare

industry, many have failed to meet the expectations

of healthcare providers and the general public

(Gagnon et al., 2010). This failure has resulted in the

slow implementation of EMR initiatives in the

healthcare industry (Boonstra and Broekhuis, 2010;

Brooks and Grotz, 2010).

The objective of this paper is to explore the

possible trends or factors which may help future

electronic medical record initiatives achieve greater

success and less failure. The first part of the paper

gives an overview of electronic medical record. In

the second part, the focus is on the enabling factors

that will enable future EMR initiatives to achieve

greater success. The third part discusses the practical

and research implications for implementing

successful EMR initiatives.

2 METHOD

A literature review, based on research articles from

2001 to 2011, was used to explore the possible

trends or factors which may help future electronic

medical record initiatives achieve greater success

and less failure. The methodology involves a review

of relevant publications, found and accessed with the

help of ProQuest (with multiple databases option)

and EBSCOhost databases. Additional sources were

Bonney W..

ENABLING FACTORS FOR ACHIEVING GREATER SUCCESS IN ELECTRONIC MEDICAL RECORD INITIATIVES.

DOI: 10.5220/0003686200050011

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2012), pages 5-11

ISBN: 978-989-8425-88-1

 2012 SCITEPRESS (Science and Technology Publications, Lda.)

retrieved using the SAGE Journals Online,

ScienceDirect, Google Scholar, and ACM digital

libraries. The targeted search terms consisted of the

combination of keywords and/or phrases including:

(a) electronic medical record; (b) electronic medical

record AND success factors; (c) electronic medical

record AND success; and (d) electronic medical

record AND interoperability.

Overall, 467 articles were identified and 34 of

them were reviewed in full. Findings from the

reviewed papers are synthesized, paraphrased (in

some cases quoted) and categorized under four

broad themes: Overview of Electronic Medical

Record; Enabling Factors; Research and Practical

Implications; and Conclusion. Studies were included

in the analysis if they reported on successful factors

to implementing and using electronic medical

record.

3 OVERVIEW OF ELECTRONIC

MEDICAL RECORD (EHR)

Electronic Medical Record (EMR) may be defined

as a modern computerized medical information

system that collect, store, share, and display patient

information (Boonstra and Broekhuis, 2010; Brooks

and Grotz, 2010; Hsieh, 2010). EMR systems are the

newest form of documenting and storing pertinent

patient’s information including demographics,

medical history, allergies, diagnosis, procedures,

prescriptions, medications, laboratory results, and

insurance information (Brooks and Grotz, 2010;

Venkatraman et al., 2008). Beiter, Sorscher,

Henderson, and Talen (2008) emphasized on the

importance of EMR in the healthcare industry by

asserting that EMR systems are the future of primary

care.

EMR is not an Electronic Health Record (EHR),

which in itself is essentially a “repository of

information regarding the health status of a subject

of care in computer processable form, stored and

transmitted securely, and accessible by multiple

authorized users” (International Organization for

Standardization (ISO/TC 215), 2005, p. 2). The

EMR is, however, a special case of the EHR

restricted in scope to the medical domain (ISO/TC

215, 2005). EMR systems have the potential to

revolutionalize and transform healthcare delivery by

increasing efficiency of healthcare services; and

improving quality of care and patient satisfaction

(Al-Azmi et al., 2009; Beiter et al., 2008; Williams

and Boren, 2008).

The benefits of adopting EMR systems in the

healthcare domain are enormous (Jones & Kessler,

2010). The principal benefits for using EMR

systems are their capabilities to increase adherence

to clinical practice guidelines; enhance surveillance

and monitoring; facilitate clinical decision-making

process; decrease medication errors; reduce paper,

printing and transcribing costs; improve availability

of charts, improve co-ordination of care; increase

legibility of clinical data; and improve quality of

care, safety, and patient education (Beiter et al.,

2008; Jones and Kessler, 2010; Linz and Fallon Jr.,

2008; Shachak et al., 2009; Williams and Boren,

2008). Despite its enormous benefits, many

healthcare organizations have been slow to adopt the

EMR technology (Jones and Kessler, 2010; McGrath

et al., 2007). This is partly due to several factors that

act as barriers to the successful implementation of

EMR initiatives.

4 ENABLING FACTORS

In a case study conducted to explore factors that

have continuously influenced the successful

implementation of EMR systems, Gagnon et al.

(2010) identified six key enabling factors to be

critical: individual factors; professional factors;

organizational factors; contextual, political, and

financial factors; legal factors; and technological

factors. The following sections describe how these

six factors, proposed by Gagnon et al. (2010), can be

applied effectively and successfully to EMR

initiatives.

4.1 Individual Factors

Gagnon et al. (2010) identified individual factors to

comprise of both personal characteristics and

attitudes of healthcare providers. According to

Gagnon et al. (2010), identifying individuals within

an organization who exhibit unique characteristics

and greater openness to technology adoption will

serve as an agent of change. Klehr, Hafner, Spelz,

Steen, and Weaver (2009) echoed similar assessment

by noting that one of the key factors to

implementing successful EMR systems involves

close collaboration amongst individual staff

members and information technology staff with

close support from the project leader.

Drawing upon the ethnographic study by Ventres

et al. (2006), Beiter et al. (2008) noted that patients’

attitudes and comfort with computers influenced

their beliefs and concerns about the use of EMR

HEALTHINF 2012 - International Conference on Health Informatics

systems. Clinicians and other healthcare

practitioners’ openness to change and familiarity

with informatics may play a crucial role in

explaining variability in adoption between

individuals within the same profession (Gagnon et

al., 2010). The implementation of EMR systems

may be resisted if users are deficient in computer

skills and are not satisfied with the system design

(Al-Azmi et al., 2009; Van Der Meijden et al.,

2003). However, professionals in the healthcare

industry who are knowledgeable about computers

and open to change will embrace the adoption of

EMR systems without much resistance.

4.2 Professional Factors

The professional factors focus on the workload,

workflow, and teamwork processes in a local

clinical setting (Gagnon et al., 2010). Many

clinicians work in a time-constrained environment

with heavy schedule and frequent interruptions.

EMR systems are, therefore, used by time-pressured

and frequently interrupted healthcare providers,

many of whose workflows are too idiosyncratic for

effective automation (Walker, 2005). Thus, fostering

the adoption of EMR initiatives requires the

development of healthcare information systems that

is enabling and not constraining to the workflow of

clinicians.

For the EMR systems to be truly useful and

successful, Clarke, Hartswood, Procter, and

Rouncefield (2001) and Hoffmann (2009) noted that

the technology and work practices must be able to

co-evolve and fit seamlessly into clinicians’ routine

workflow. Specifically, Clarke et al. (2001) noted

that “IT design and development methodologies

must support user-led change processes, adapting the

technology to meet users’ needs as these emerge

through use” (p. 170). It is therefore very important

that EMR systems are strategically aligned with

clinical and administrative processes (Venkatraman

et al., 2008).

4.3 Organizational Factors

The premise of organizational factors focuses on

leadership and a presence of a champion (Gagnon et

al., 2010). Successful implementation of EMR

initiatives will require a leader who will champion

the development of EMR systems. Canada Health

Infoway (2011) suggested the need for the project

leader and/or champion to take charge in the

implementation of EMR systems. Gagnon et al.

(2010) found that active involvement of the project

champion in system design, coupled with on-site

technical support to all users were the solutions put

forward to help overcome most of the obstacles

facing the adoption of EMR systems in clinical

settings.

Organizations pursuing EMR initiatives should

have in place an availability of evidence-based

implementation strategy. Klehr et al. (2009)

emphasized on the need to use readily available

expert resources. These expert resources should be

researched, well-thought, and developed by the

project leader/champion before the initiation of the

EMR project. Gagnon et al. (2010) found that the

existence of a planned strategy based on the

literature on Information and Communication

Technology (ICT) adoption played an important role

in the implementation of EMR systems.

The organization’s innovation culture and

openness to change is also very critical in

influencing the success of EMR initiatives.

According to Gagnon et al (2010), “the state of

organisational readiness for change not only affects

the computerisation of the medical record, but also

everything that it involves in terms of changes” (p.

36). Boonstra and Broekhuis (2010) reaffirmed that

the success of EMR initiatives depends on the

quality of change management and thus the process

of implementing EMR initiatives should be treated

as change management projects and led by

implementers and/or change managers

knowledgeable in medical practices.

4.4 Contextual, Political, and Financial

Factors

The context in which the EMR initiative is

undertaken is very important in establishing success.

Introducing the EMR technology into “complex

work and organizational settings are often

unpredictable, and can only be determined in the

context of use” (Clarke et al., 2001, p. 170). There

exist differences in how the implementation of the

EMR technology is embraced in the rural setting

versus urban settings. Al-Azmi et al. (2009) and

Williams and Boren (2008) also identified

differences on how they are embraced in developed

versus developing countries. Acknowledging the

fact that most developed countries implement EMR

systems because of its associated benefits, Williams

and Boren (2008) noted that the transition from the

traditional paper-based system to EMR systems

often brings some level of fear and resistance to

change in the developing countries. These

ENABLING FACTORS FOR ACHIEVING GREATER SUCCESS IN ELECTRONIC MEDICAL RECORD

INITIATIVES

perceptions have undermined the widespread

adoption of EMR systems in the healthcare industry.

The political will to invest in EMR initiatives is

essential in achieving success in their

implementation (Jones and Kessler, 2010). The

government readiness and willingness in supporting

EMR initiative is always helpful in launching the

project in a given national setting or climate

(Gagnon et al., 2010). For example, in a study

conducted in Taiwan to identify factors that affect

hospitals’ willingness to implement EMR initiatives,

Chang, Hwang, Hung, Kuo, and Yen (2009) found

that perceived benefits, uncertainty, influence and

reciprocal investments had significant impact on the

decision to implement EMR initiatives.

The success of EMR initiatives also depend on

the availability of funding (Brooks and Grotz, 2010;

Callan and DeShazo, 2007; Canada Health Infoway,

2011; Cavolo, 2007; Gagnon et al., 2010; Kumar

and Aldrich, 2010). Brooks and Grotz (2010) even

made it clearer by noting that funding is the largest

setback to implementing EMR initiatives. The use of

health information systems and their associated

technical support all require significant financial

investment and ongoing maintenance. Gagnon et al.

(2010) emphasized on the importance of financial

investment by noting that implementing EMR

systems require additional costs in terms of

equipment, contracts and human resources. Such

additional costs may include restructuring workflow

in clinical settings; knowledge transfer to

employees; and in-house IT support and training

(Beiter et al., 2008; O'Neill and Klepack, 2007).

Inadequate training of personnel is a disaster for

EMR adoption (Callan and DeShazo, 2007).

Williams and Boren (2008) considered in-house

training of healthcare providers as one of the key

elements to the success of EMR initiatives.

4.5 Legal Factors

The healthcare industry is plagued with legal actions

when it comes to the accessibility of personalized

health information contained in an electronic format.

According to Myers, Frieden, Bherwani, and

Henning (2008), the availability of personalized

health information in electronic format threatens the

integrity, confidentiality, security and privacy of

health data. Unauthorized access to these

personalized data often leads to liabilities that

require proper security protocols and management

from the part of the healthcare provider.

Successful implementation and adoption of EMR

systems has been slow and a long process because of

privacy and confidentiality policies surrounding the

use of the system (Brooks & Grotz, 2010). The

United States Congress enacted the Health Insurance

Portability and Accountability Act (HIPAA) in 1996

with the goal of setting up regulations to standardize

the collection, storage, and dissemination of

personalized health information (Brooks and Grotz,

2010; Harrison and Ramanujan, 2011; Hoffmann,

2009). However, the implementation of these

regulations regarding the secure exchange of clinical

information between the various EMR users across

settings of care is not an easy endeavour and still

represents a complex issue (Gagnon et al., 2010, p.

37). Brooks and Grotz (2010) also made similar

assessment by noting that “it is commonly

acknowledged that the regulation is insufficient to

cover the new and swiftly developing e-health

environment presented as a result of the EMR

system” (p, 76). For example, HIPAA does not

address data ownership (Hoffmann, 2009).

Williams and Boren (2008) therefore

recommended the need for the development of

privacy, confidentiality, and security principles to

protect patients’ interests against inappropriate

access to their personalized health data. The

introduction of proper IT Governance framework

that establishes control and accountability of health

data will also be fruitful in protecting the integrity of

personalized health information. Kahn, Aulakh, and

Bosworth (2009) correctly noted that widespread

consumer acceptance and adoption of healthcare

information systems is not possible until all issues

relating to data security, identity protection, and

consumer satisfactions are resolved by dedicated

national bodies.

4.6 Technological Factors

There are uncertainties or disagreements amongst

healthcare IT professionals on the appropriate core

components of EMR systems (Hsieh, 2010). Hseih

(2010) argued that most of the core components of

EMR systems have typically been drawn from

marketing campaigns of products rather than from

standard specifications. Establishing appropriate

core components of EMR systems requires

technologies that utilize health data standards and

interoperability.

4.6.1 Health Data Standards

Health data standards are critical for developing the

core components of the EMR system. The standards

need to explicitly specify how data is presented,

HEALTHINF 2012 - International Conference on Health Informatics

captured, stored, and conveyed (W. Hammond,

Bailey et al., 2010). The idea of using health data

standards is to enable disparate EMR systems to

exchange clinical information in an integrated

healthcare environment, thereby, facilitating greater

integration and cohesion of healthcare services

(Clarke et al., 2001). The health data standards

should support the collection, storage, exchange, and

retrieval of electronic medical information for the

EMR system (Hoffmann, 2009).

Similarly, W. E. Hammond (2005) claimed that

health data standards are needed in order to create

aggregated, patient-centric EMR systems. W. E.

Hammond (2005) went further and recommended

the need for the “creation of a neutral, nonprofit

organization in the private sector with the authority

to manage all aspects of health data standards” (p.

1213). According to Venkatraman et al. (2008), the

use of clinical data exchange standards in EMR

systems is one of the key strategies in ensuring that

EMR systems deliver business value to the

healthcare IT community. The availability of health

data standards is very useful in supporting the

interoperability of EMR systems.

4.6.2 Interoperability

Interoperability is one of the main enabling

technologies for the utilization of EMR in integrated

healthcare information systems. W. Hammond et al.

(2010) defined interoperability as the “ability to

communicate and exchange data accurately among

different IT systems, software applications, and

networks” (p. 284). The interoperability concept is

divided into three distinct levels of functionality:

interface engine, functional interoperability, and

semantic interoperability (Freedman, 2007; ISO/TC

215, 2005).

Acknowledging the fact that semantic

interoperability is the most sophisticated form of

interoperability, Freedman (2007) indicated that

semantic interoperability “allows two systems not

only to share information, it also enables the

receiving system to understand and make use of the

incoming data while maintaining the original

meaning of that data” (p. 50). These functionalities

of interoperability have facilitated the development

of classification and terminology standards that are

currently used in the development of EMR systems.

W. Hammond et al. (2010) noted that

interoperability cannot be achieved without the

existence of health data standards that are agreed

upon by dedicated national bodies.

5 PRATICAL AND RESEARCH

IMPLICATIONS

The benefits of using EMR systems in medical

practice are numerous. The use of EMR systems will

enable physicians at the point of care to provide

evidence-based medicine and improve the efficiency

of healthcare delivery. Healthcare providers are

capable of influencing the implementation of

effective EMR systems if they are passionately

committed to transforming the ways they provide

care for patients (Walker, 2005). Improvement in

clinical outcomes depends heavily on the successful

implementation and adoption of EMR systems

(Diamond & Shirky, 2008).

Using a phase implementation approach will

ensure that all the critical success factors identified

in the paper are applied appropriately to EMR

initiatives. Walker (2005) noted that an “EMR

implementation that is capable of supporting less

error-prone care processes will require substantial

resources for workflow analysis, software

configuration, testing, and user training” (p, 1118).

There is a general consensus among many

researchers that successful implementation of EMR

initiatives will require good planning, strong

management and physician leadership, supportive

staff, and ongoing IT support (Gagnon et al., 2010;

Williams and Boren, 2008).

Establishing semantic interoperability in EMR

systems is one of the critical factors in ensuring that

EMR initiatives are successful with less failure. The

lack of standards and structured data definitions for

EMR systems contributes to the difficult in

achieving interoperability in many existing EMR

systems (Kumar & Aldrich, 2010). Hence,

developing an integrated IT architecture and

infrastructure to support EMR systems will enable

hospitals to get better results and provide high

quality services to patients.

Achieving successful implementation of EMR

initiatives will also require some trade-offs.

Acknowledging the fact that there exists a trade-off

between achieving rapid implementation of EMR

technology and strong healthcare privacy laws,

Brooks and Grotz (2010) noted that while healthcare

privacy laws remain positive for healthcare

consumers, it does not always allow for quick EMR

systems implementation. Accommodating this trade-

off will involve finding the right balance between

standardization and flexibility. Whereas

standardization ensures interoperability and secure

exchange of clinical information, flexibility

accommodates the various systems and architectures

ENABLING FACTORS FOR ACHIEVING GREATER SUCCESS IN ELECTRONIC MEDICAL RECORD

INITIATIVES

that different healthcare providers need (Hoffmann,

2009).

6 CONCLUSIONS

This paper has explored the possible trends or

factors which may help future EMR initiatives

achieve greater success and less failure. Healthcare

providers are encouraged to develop strategic

initiatives to influence the successful adoption of

EMR systems. There is an expectation that low

implementation cost and making the technology

appealing to physicians will stimulate and accelerate

the adoption of EMR initiatives in medical practice

(Bristol, 2005). Although several challenges are

facing the adoption of EMR in medical practice,

there is strong evidence from the literature that when

properly developed and deployed, EMR systems will

benefit the healthcare community in establishing

efficient and quality healthcare delivery and

evidence-based practice (Al-Azmi et al., 2009;

Beiter et al., 2008; Williams and Boren, 2008).

EMR systems continue to remain attractive to

many healthcare providers. However, the cost of

ownership cannot be ignored (Callan and DeShazo,

2007; Cavolo, 2007; Kumar and Aldrich, 2010;

O'Neill and Klepack, 2007; Venkatraman et al.,

2008). The cost of owning EMR systems does not

come with other needed day-to-day operational

maintenances and upgrade to the systems as well as

technical support. With the looming cost of

ownership of the EMR systems, many researchers

have recommended the need for the availability of

evidence-based implementation strategy to guide

project leaders (Chang et al., 2009; Gagnon et al.,

2010). Gagnon et al. (2010) found that the

involvement of project leaders in systems design, as

well as on-site technical support to all users are very

critical in helping overcome the obstacles facing the

adoption and implementation of EMR initiatives.

Change management also plays an important role

in the successful implementation of EMR initiatives

(Boonstra and Broekhuis, 2010). The development

of appropriate and strategic change management

processes in healthcare organizations could be an

incentive to accelerate the adoption in EMR systems

in medical practice. Healthcare providers and policy

makers can promote EMR initiatives by identifying

desirable stakeholders and partners that will form a

strategic alliance to meet the dynamic challenges in

the healthcare industry (Chang et al., 2009; Clarke et

al., 2001). Future research should therefore focus on

developing an appropriate IT governance structure

or framework that will guide project leaders in

championing the successful implementation of EMR

initiatives.

REFERENCES

Adler-Milstein, J., and Bates, D. W. (2010). Paperless

healthcare: Progress and challenges of an IT-enabled

healthcare system. Business Horizons, 53(2), 119-130.

doi:10.1016/j.bushor.2009.10.004

Al-Azmi, S., Al-Enezi, N., and Chowdhury, R. I. (2009).

Users' attitudes to an electronic medical record system

and its correlates: A multivariate analysis. Health

Information Management Journal, 38(2), 33-40.

Beiter, P. A., Sorscher, J., Henderson, C. J., and Talen, M.

(2008). Do electronic medical record (EMR)

demonstrations change attitudes, knowledge, skills or

needs? Informatics in Primary Care, 16(3), 221-227.

Boonstra, A., & Broekhuis, M. (2010). Barriers to the

acceptance of electronic medical records by physicians

from systematic review to taxonomy and

interventions. BMC Health Services Research, 10,

231-247. doi:10.1186/1472-6963-10-231

Bristol, N. (2005). The muddle of US electronic medical

records. The Lancet, 365(9471), 1610-1611.

Brooks, R., & Grotz, C. (2010). Implementation of

electronic medical records: How healthcare providers

are managing the challenges of going digital. Journal

of Business & Economics Research, 8(6), 73-84.

Callan, C. M., & DeShazo, C. (2007). How to navigate

health care information technology and electronic

medical records. Physician Executive, 33(6), 36-42.

Canada Health Infoway. (2011). EMR success factors.

Retrieved April 21, 2011, from https://www.infoway-

inforoute.ca/working-with-ehr/health-care-

providers/emrs/success-factors

Cavolo, D. (2007). Electronic medical record systems:

Know the total cost of ownership: Long term

management care. Long-Term Living, 56(7), 17-19.

Chang, I., Hwang, H., Hung, M., Kuo, K., & Yen, D. C.

(2009). Factors affecting cross-hospital exchange of

electronic medical records. Information &

Management, 46(2), 109-115.

doi:10.1016/j.im.2008.12.004

Clarke, K. M., Hartswood, M. J., Procter, R. N., &

Rouncefield, M. (2001). The electronic medical record

and everyday medical work. Health Informatics

Journal, 7(3-4), 168-170. doi:10.1177/1460458

20100700310

Diamond, C., & Shirky, C. (2008). Health information

technology: A few years of magical thinking? Health

Affairs, 27(5), 383-390.

Freedman, I. (2007). What does "interoperability" really

mean? Health Management Technology, 28(10), 50-51.

Gagnon, M., Desmartis, M., Labrecque, M., Légaré, F.,

Lamothe, L., Fortin, J., Rancourt, J., and Duplantie, J.

(2010). Implementation of an electronic medical

record in family practice: A case study. Informatics in

HEALTHINF 2012 - International Conference on Health Informatics

Primary Care, 18(1), 31-40.

Hammond, W., Bailey, C., Boucher, P., Spohr, M., &

Whitaker, P. (2010). Connecting information to

improve health. Health Affairs, 29(2), 284-288.

Hammond, W. E. (2005). The making and adoption of

health data standards. Health Affairs, 24(5), 1205-

1213.

Harrison, P. J., & Ramanujan, S. (2011). Electronic

medical records: Great idea or great threat to privacy?

The Review of Business Information Systems, 15(1), 1-7.

Hoffmann, L. (2009). Implementing electronic medical

records. Communications of the ACM, 52(11), 18-20.

Hsieh, C. (2010). Electronic medical record system:

Current status and its use to support universal

healthcare system. Communications of the IIMA,

10(3), 79-97.

International Organization for Standardization (ISO/TC

215). (2005). Health informatics — electronic health

record — definition, scope, and context. Geneva,

Switzerland: ISO. Retrieved from http://www.openehr.

org/downloads/standards/iso/isotc215wg3_N202_ISO-

TR_20514_Final_%5B2005-01-31%5D.pdf

Jones, D. S., and Kessler, H. B. (2010). Can electronic

medical records really improve quality? The Obama

administration bets yes. Journal of Health Care

Compliance, 12(1), 39-42, 67-68.

Kahn, J., Aulakh, V., & Bosworth, A. (2009). What it

takes: Characteristics of the ideal personal health

record. Health Affairs, 28(2), 369-376.

Klehr, J., Hafner, J., Spelz, L. M., Steen, S., & Weaver, K.

(2009). Implementation of standardized nomenclature

in the electronic medical record. International Journal

of Nursing Terminologies & Classifications, 20(4),

169-180.

Kumar, S., and Aldrich, K. (2010). Overcoming barriers to

electronic medical record (EMR) implementation in

the US healthcare system: A comparative study.

Health Informatics Journal, 16(4), 306-318.

doi:10.1177/1460458210380523

Linz, A. J., and Fallon Jr., L. F. (2008). Public perceptions

regarding the impact of electronic medical records on

health care quality and medical errors. Journal of

Controversial Medical Claims, 15(2), 10-15.

McGrath, J. M., Arar, N. H., & Pugh, J. A. (2007). The

influence of electronic medical record usage on

nonverbal communication in the medical interview.

Health Informatics Journal, 13(2), 105-118.

doi:10.1177/1460458207076466

Myers, J., Frieden, T. R., Bherwani, K. M., & Henning, K.

J. (2008). Privacy and public health at risk: Public

health confidentiality in the digital age. American

Journal of Public Health, 98(5), 793-801.

O'Neill, L., and Klepack, W. (2007). Electronic medical

records for a rural family practice: A case study in

systems development Springer Science & Business

Media. doi:10.1007/s10916-006-9040-1

Shachak, A., Hadas-Dayagi, M., Ziv, A., and Reis, S.

(2009). Primary care physicians’ use of an electronic

medical record system: A cognitive task analysis.

JGIM: Journal of General Internal Medicine, 24(3),

341-348. doi:10.1007/s11606-008-0892-6

Van Der Meijden, M. J., Tange, H. J., Troost, J., &

Hasman, A. (2003). Determinants of success of

inpatient clinical information systems: a literature

review. Journal of the American Medical Informatics

Association, 10(3), 235-243.

Venkatraman, S., Bala, H., Venkatesh, V., & Bates, J.

(2008). Six strategies for electronic medical records

systems. Communications of the ACM, 51(11), 140-

144.

Ventres, W., Kooienga, S., Vuckovic, N., Marlin, R.,

Nygren, P., and Stewart, V. (2006). Physicians,

patients, and the electronic health record: an

ethnographic analysis. Annals of Family Medicine,

4(1), 124–31.

Walker, J. M. (2005). Electronic medical records and

health care transformation. Health Affairs, 24(5),

1118-1120. doi:10.1377/hlthaff.24.5.1118

Williams, F., & Boren, S. A. (2008). The role of electronic

medical record in care delivery in developing

countries. International Journal of Information

Management, 28(6), 503-507. doi:10.1016/j.ijinfomgt.

2008.01.016

ENABLING FACTORS FOR ACHIEVING GREATER SUCCESS IN ELECTRONIC MEDICAL RECORD

INITIATIVES