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Open Access Research article

No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record

Jan-Tore Lium1*, Aksel Tjora2 and Arild Faxvaag3

Author affiliations

1 Department of Industrial Economics and Technology Management, and Norwegian Research Centre for Electronic Patient Records, Norwegian University of Science and Technology (NTNU), Norway

2 Department of Sociology and Political Science, and Norwegian Research Centre for Electronic Patient Records, Norwegian University of Science and Technology (NTNU), Norway

3 Norwegian Research Centre for Electronic Patient Records, Faculty of medicine, Norwegian University of Science and Technology (NTNU), Norway

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Citation and License

BMC Medical Informatics and Decision Making 2008, 8:2  doi:10.1186/1472-6947-8-2

Published: 10 January 2008

Abstract

Background

It has been shown that implementation of electronic medical records (EMR) and withdrawal of the paper-based medical record is feasible, but represents a drastic change in the information environment of hospital physicians. Previous investigations have revealed considerable inter-hospital variations in EMR system use and user satisfaction. The aim of this study was to further explore changes of clinicians' work after the EMR system implementation process and how they experienced working in a paper-deprived information environment.

Methods

Qualitative study based on 18 semi-structured interviews with physicians in two Norwegian hospitals.

Results

Ten different but related characteristics of work within the EMR-based practice were identified; (1) there was closer clinical and administrative cooperation during the implementation processes; (2) there were greater benefits when everybody used the system; (3) systems supported freshmen better than experienced physicians; (4) the EMR was useful in regard to professional learning; (5) new users were given an introduction to the system by experienced; (6) younger clinicians reported different attitudes than senior clinicians, but this might be related to more than age and previous experience with computers; (7) the EMR made it easier to generate free-text notes, but this also created a potential for information overflow; (8) there is little or no support for mobile work; (9) instances of downtime are still experienced, and this influenced the attitude towards the system and (10) clinicians preferred EMR-only compared to combined paper and electronic systems.

Conclusion

Despite the removal of paper-based records from clinical workflow (a change that hospital clinicians perceived as highly useful), many of the old routines remained unchanged, limiting the potential of the EMR system. Thus, there is a need to not only remove paper in the physical sense, but also to established routines to fully achieve the benefits of an EMR system.