Randeree E et al. 2007 "Exploring physician adoption of EMRs: a multi-case analysis."

Randeree E. Exploring physician adoption of EMRs: a multi-case analysis. J Med Syst 2007;31(6):489-496.
"The adoption of new technology within healthcare has been promoted as a way to reduce costs and increase efficiencies as well as improve quality. The literature has documented a significant number of implementation failures by large groups and hospitals with access to IT skills and resources. Given the low adoption rate among physicians, the challenges facing small practices can be daunting. While financial and technical barriers have been explored at the physician level, the actual implementation challenges facing small groups have not been explored. This paper presents a qualitative three case analysis of physician groups that have employed EMRs and the pre and post adoption insights. Results show that planning was a key common variable missing; the anticipated downtime was longer than expected and the workflow disruption and maintenance costs were underestimated."

1) To "look at the actual versus expected costs and benefits that small practices encounter" in electronic medical record (EMR) adoption, 2) to "look at what items or concerns caused the budget to increase and what primary themes should be investigated prior to the adoption of EMRs (trust, customizability, supplier presence, and costs)," and 3) to document "the implementation of EMRs in small practices and provide a roadmap for others to follow."

Tools Used
Type Clinic
Specialty care
Type Specific
Small and/or medium
Other Information
The sample consisted of three private small group practices all within a 60-mile radius. The sample clinics were established practices, were randomly selected, and made EMR adoption decisions within a similar time-frame.
Type of Health IT
Electronic medical records (EMR)
Workflow-Related Findings
Case 1: 'staff spent longer hours interacting with the system and were dismayed because they "thought this was supposed to be better [than the paper system]." '
In Case 1, some employees had to be retrained. In Case 3, some employees left the practice, and they needed to hire skilled information technology (IT) people with medical experience. In Cases 1 and 3, the business manager's role shifted to being primarily system operations.
Cases 1 and 3: because they were unable to immediately incorporate old patient charts into the EMR, they had to operate with redundant workflows, using the EMR for new patients and paper charts for prior patients.
Case 3: customization of the system is slow, limiting usability.
Study Design
Pre-postintervention (no control group)
Study Participants
Study participants were grouped into three cases. Case one involved eight physicians, one nurse practitioner (NP), two technicians, 20 office staff, and one location. Case two involved nine physicians, four physician assistants (PA), four physical therapists, five registered nurses (RN), 80 office staff, and three locations. Case three involved three physicians, one PA, two NPs, 24 office staff and three locations.