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The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems.

Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel.

The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication.

Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel.

Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues.

Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood.

Advanced Electronic Medical Records (EMR) provide many potential benefits to hospitals. However, because of their broad scope, many stakeholders deal with the EMR and a continuous effort has to be made to keep up with internal and external change. Therefore, hospitals need to deliberately shape their organizational competencies considering the pursuit of alignment, i.e. making sure that the EMR remains optimally aligned with strategies, goals and needs of the hospital and its stakeholders. This paper aims to investigate the evolutionary paths of these alignment competencies and their drivers, from a theoretical perspective of co-evolutionary information systems alignment (COISA).

This paper reports on a longitudinal multiple case study of three Dutch hospitals which each recently implemented an advanced EMR system. The authors conducted 35 in-depth interviews in 2 phases (before and after go-live of the EMR), and studied documentation related to the EMR implementations.

The findings show that each hospital's COISA capability shows a different evolutionary path. However, two of the three case hospitals ended up coordinating part of their COISA capability to an ecosystem level, i.e. they incorporated other hospitals using the same EMR system to coordinate their alignment efforts, either from an operational perspective, or in terms of orchestration and strategy. The found evolutionary paths' key drivers include “stakeholder initiative”, “accumulating experience”, “driving events” and “emerging issues”.

The findings help healthcare practitioners to deliberately shape their organization's COISA capability in pursuit of EMR alignment. Furthermore, the authors add to the knowledge base on co-evolutionary approaches to alignment through the longitudinal approach.

The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors.

The case study approach provides a detailed analysis of individuals within an organizational unit. Using a theoretical lens of sensemaking and readiness for change gives a framework for triangulated inquiry.

Findings reveal that physicians' key sensemaking factors are alignment, expectations, symbols (i.e. voice activation technology), outside influences, emotional arousal, trust, faith, forced implementation, controlled influence, and clarification of identity. These factors collectively describe how physician derive meaning through innovation.

The findings elucidate physicians as autonomous learners utilizing innovative thought processes to prepare for EMR implementation. Physicians used innovation in EMR implementation as a method of controlled influence to clarify their identity as efficient, competent professionals who demand performance excellence.

These findings have implications for EMR implementation strategies and future research in innovation and EMR adoption behaviors.

This study provides needed information about how physicians grasp EMR technology in the practice of medicine and how it impacts their readiness to use EMR. Much is known about the barriers, difficulties, and benefits of EMR, but little is know about how physicians construct meaning from the use of this new technology.

This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our study's findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.

The purpose of this article is to present a conceptual model that posits the strategic relationships between information technology, clinic operations and physicians and the subsequent outcomes to patients, physicians and clinics which can lead to competitive advantages in the healthcare environment.

This paper is based on a review of the literature and proposes a conceptual model of the strategic relationships essential for success. The scope of the paper is based on the legal, economic and political triggers impacting the strategic relationship between electronic medical records, clinic interoperability and physicians as owners/users.

The paper presents the formation of a conceptual model which identifies the strategic alignment between clinics, physicians and information technology, more specifically, electronic medical records.

This paper is limited in that it is not an empirical investigation but a conceptual model of future research endeavours. Future research endeavours should seek empirical findings related to the relationships proposed in the model.

Physicians, clinics and patients should be aware of the impact electronic medical records have on the health environment as well as the potential competitiveness due to health consumerism enabled by electronic medical records.

Electronic medical records, personal health records and electronic health records are infiltrating society; subsequently health consumers should determine how this technology may impact their healthcare.

The value of this paper is to provide a conceptual model as a basis for future empirical research and awareness of changes in the competitiveness of the healthcare environment.

Leaders in health-care organizations introducing electronic medical records (EMRs) face implementation challenges. The adoption of EMR by the emergency medical and ambulance setting is expected to provide wide-ranging benefits, but there is little research into the processes of adoption in this sector. The purpose of this study is to examine the introduction of EMR in a small emergency care organization and identify factors that aided adoption.

Semi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company.

The user interfaces with the EMR, and perceived ease of use, were important factors affecting adoption. Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced flexibility of use, this enhanced both individual and collective ability to make sense of the change and removed barriers to acceptance.

This is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR.

Leaders introducing EMR in similar situations may benefit from considering a sense-making perspective and responding promptly to feedback.

The study contributes to a wider understanding of issues faced by leaders who seek to implement EMRs in emergency medical services, a sector in which there has been to date very little research on this issue.

The purpose of this paper is to investigate why physicians in the USA have been reluctant to embrace electronic medical record (EMR) technology. More specifically, the present study aims to examine physicians' perceptions regarding the importance of various functions of EMR systems and the extent to which physician characteristics were related to the perceived importance of the functions.

A mail survey was sent to 358 physicians affiliated with a large, multi‐specialty clinic located in the Midwest region of the USA.

Although previous studies suggest that the age, computer sophistication, and medical specialty of physicians impacts the extent to which they use EMR technology, the present study found very little evidence that these characteristics of the physicians were related to the perceived importance of EMR functions.

Since the results demonstrate that physicians view EMR technology as highly important, it was concluded that difference in the use of EMR technology among physicians was not primarily the result of differences in the perceived importance of EMR technology. Rather, it appears that a lack of computer skills may account for much of the resistance to adopting EMR technology. Thus, training to increase computer proficiency among physicians may be the key to increasing the acceptance of EMR technology.

The paper provides useful information on physicians' perceptions of EMR technology.

Aims to understand the managerial implications of the perceptions hospital physicians and nurses hold toward the introduction of electronic medical records (EMRS). In‐depth interviews were used with 18 hospital physicians and eight nurses from several different hospital wards at a large government‐run, university‐affiliated hospital in Israel, where EMRs were gradually introduced over the last 20 years. Physicians identified six different domains of impact. Senior physicians, most of whom held managerial roles, tended to emphasise managerial outcomes and to view these as positively affecting their organisations. Junior doctors emphasised mostly negative occupational effects of the EMR on their work – including limits to professional autonomy, heavier administrative burdens, and reinforcement of existing professional hierarchies. Nurses identified different domains and saw benefits for quality and administration of patient care.

Purpose: This chapter examines how healthcare technologies (electronic medical records, personal cell phones, and pagers) help manage patient care work to accelerate processes of communication and blur boundaries between work time and non-work time, thereby revealing dynamics of power as indicated through temporal capital, or the amount of time under an individual’s control.

Method: The data were collected from 35 in-depth semistructured interviews of health practitioners, which included 26 physicians, 7 nurses, and 2 administrators.

Findings: Communication technologies fulfill promises of temporal autonomy and efficiency, but not without cost, particularly as it intersects with organizational/institutional power structures and non-work-related social factors such as pre-existing technological literacy and proficiency. The blurring of work and non-work time gives practitioners perceived higher quality of life while also increasing temporal flexibility and autonomy. The higher up one is in the relevant hierarchy, the more control one has over one’s own time, resulting in higher levels of temporal capital. The power hierarchies serve to complicate the potential recuperation of temporal capital by communication technologies.

Implications: This study uses a critical cultural perspective that takes into consideration structures of institutional power hierarches impact temporal organization through the use of communication technologies by health practitioners. Practitioner-facing research is particularly crucial given the high rates of burnout within the profession and concerns around the well-being of health practitioners, and autonomy and control over one’s time is a factor in work and life satisfaction.