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Open Access Research article

Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study

Carrie Anna McGinn1, Marie-Pierre Gagnon23*, Nicola Shaw4, Claude Sicotte5, Luc Mathieu6, Yvan Leduc7, Sonya Grenier2, Julie Duplantie7, Anis Ben Abdeljelil2 and France Légaré28

Author Affiliations

1 Institut de réadaptation en déficience physique de Québec, Québec, Canada

2 Research Centre of the Centre hospitalier universitaire de Québec, Québec, Canada

3 Faculty of Nursing, Université Laval, Québec, Canada

4 Health Informatics Institute, Algoma University, Algoma, Sault-Sainte-Marie, Canada

5 Department of Health Management, Université de Montréal, Montréal, Canada

6 Department of Nursing, Université de Sherbrooke, Sherbrooke, Canada

7 Department of Social and Preventive Medicine, Université Laval, Québec, Canada

8 Department of Family and Emergency Medicine, Université Laval, Québec, Canada

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BMC Medical Informatics and Decision Making 2012, 12:105  doi:10.1186/1472-6947-12-105

Published: 11 September 2012



Interoperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users’ perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature.


A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75%) or moderate (≥ 60-74%) according to user groups’ level of agreement on applicability and importance, partial (≥ 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance.


Three Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (≥ 75% from questionnaire answers of user groups), for decision-making concerning EHR implementation. The10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and workload, resources availability, management, outcome expectancy, and interoperability.


Amongst all factors influencing EHR implementation identified in a previous systematic review, ten were prioritized through this Delphi study. The varying levels of agreement between and within user groups could mean that users’ perspectives of each factor are complex and that each user group has unique professional priorities and roles in the EHR implementation process. As more EHR implementations in Canada are completed it will be possible to corroborate this preliminary result with a larger population of EHR users.

Delphi technique; Adoption factors; Implementation factors; Electronic health record; Health information technology; Health communication technology; Medical informatics