Introduction: The epidemic of overweight and obesity both worldwide and in Canada is indicative of the need for proper growth monitoring beginning at birth. This study evaluated Family Physician’s (FP) Level of Use (LoU) of the recommended 2006 and 2007 World Health Organization (WHO) Growth Charts for monitoring their paediatric patients’ growth. It explored factors influencing LoU, utilizing the Diffusion of Innovations (DOI) theory and Ecological Framework for Effective Implementation (EFEI) as guiding models. FPs’ awareness of resources to support paediatric weight management was also assessed. Methods: A survey was distributed to FP in British Columbia (BC), Canada (N = 2853). The survey addressed provider and innovation characteristics, prevention delivery and support system factors, and barriers and facilitators to chart use. Correlations and multiple linear regression were used to determine correlates and predictors of LoU. Results: Sixty-two surveys were returned (2.2%). WHO Growth Chart LoU was 80.4%. Six variables significantly predicted LoU, including age (β = -.28, t = -3.15, p < .05), practicing in Fraser Health Authority region (β = -.24, t = -2.67, p < .05), assessing head circumference of birth to two year olds (β = .23, t = 2.45, p < .05), perceived growth chart accessibility (β = .39, t = 4.22, p < .05) and compatibility (β = .47, t = 5.27, p < .05), and innovativeness (β = -.37, t = -4.11, p < .05). These variables accounted for 69% of the variance in LoU. The most commonly identified barrier and facilitator to chart use was related to the Electronic Medical Record (EMR) system. FPs’ awareness of resources to support overweight paediatric patients was low. Conclusion: The majority of FP in BC in this sample had adopted the WHO Growth Charts. The results showed partial support for DOI theory and EFEI derived factors. Despite a small sample size, the findings highlighted the importance of installing the charts in the EMR systems, and can provide a foundation for future public health dissemination efforts and research on medical guideline implementation. / Graduate / 0573 / 0769 / erand@uvic.ca

Made available in DSpace on 2016-06-02T19:05:42Z (GMT). No. of bitstreams: 1 2927.pdf: 7308846 bytes, checksum: 00bf87c13681e4b1b09267e924ecd6a8 (MD5) Previous issue date: 2010-02-19 / The use of Information Systems in health environments, like the substitution of paper versions of medical records by electronics ones, has improved patient assistance and allowed such information to be available in a more accessible way. Along with this technology, however, there are significant issues raised by the patients about the access control over their confidential data, which becomes more available and could be accessed by unauthorized people. It is in this scenario that Health - Privilege Management Infrastructure, or H-PMI, is presented in this work. It aims to provide a software architecture for privilege management in health environments. H-PMI aims to be adherent to the Brazilian laws and rules related to the access to electronic medical records, like the ones defined in Manual de Certificação de Sistemas da Área de Saúde by Conselho Federal de Medicina and Sociedade Brasileira de Informática em Saúde. The main objective of this work is to specify the envisioned H-PMI, so it can provide restricted access to electronic medical records in accordance with the appropriate law and recommendations security guarantees, allowing trusted access to sensitive data while allowing circumstantial access to these data in exceptional situations. In order to evaluate the applicability of the proposed H-PMI architecture we have developed the Web H-PMI, which is integrated with the Google Health platform. The obtained results show that the developed architecture can be applied in existing health environments. / A informatização dos ambientes da área de saúde, como a substituição dos prontuários em papéis por versões eletrônicas, permitiu diversas melhorias no atendimento aos pacientes, além da disponibilização de informações de forma mais acessível. Porém, com esta tecnologia surgiram preocupações maiores por parte dos pacientes em relação ao controle de acesso aos seus dados confidenciais, uma vez que com a acessibilidade facilitada, a possibilidade de pessoas não autorizadas acessarem tais dados também é ampliada. É neste cenário que está incluído o Health - Privilege Management Infraestructure, ou HPMI, tratado neste trabalho, que visa a apresentar uma Arquitetura para o Gerenciamento de Privilégios para Sistemas de Informação da área de saúde. H-PMI almeja ser aderente às normas e leis brasileiras, sendo fiel às regras de certificação de sistemas da área de saúde definidas pelo Conselho Federal e Medicina em conjunto com a sociedade Brasileira de Informática em Saúde. O objetivo deste trabalho é especificar o H-PMI, de forma que ele seja capaz de fornecer garantias de seguranças necessárias segundo a legislação vigente, permitindo um acesso legítimo a dados confidenciais, além de conceder o acesso a dados restritos em situações excepcionais em que isto é autorizado. Como resultado do desenvolvimento do trabalho proposto, implantou-se o Web H-PMI integrado com o Google Health demonstrando a capacidade de implantação de parte substancial da arquitetura proposta em ambientes existentes.

Denna studie undersöker användarupplevelsen av utbildning i journalsystemet Cosmic i Region Jönköpings län. Utbildning är av största vikt för personalens välmående samt för optimal användning av systemet. Syftet med undersökningen är att utforma en enkät för kontinuerligt förbättringsarbete inom området. Enkäten undersöker både kvantitativa och kvalitativa element hos ett urval som stratifierats utifrån användarnas yrkesroller. Enkäten skickades till deltagarnas respektive arbetsmejl, och svaren samlades in och bearbetades med hjälp av enkätprogrammet EsMaker. Ordinalskalor användes som mätverktyg i många av enkätens kvantitativa frågor, medan de kvalitativa frågorna analyserades med hjälp av The constant comparative method.  Studiens resultat visar en godtycklighet gentemot det material som finns samt med kollegor som instruktörer. Dock framkommer starka önskemål om organiserade utbildningar. Ett tydligt mönster är att användarna föredrar utbildningsmetoder som bygger på synkron kommunikation, samt att metoder som bygger på demonstration av programvaran är mer uppskattade än andra. Resultaten visar dock att dessa metoder bör kombineras med övningar för bästa effekt.  Slutsatser som undersökningen genererat är att kommande utbildningsinsatser bör innebära organiserade utbildningar på arbetsplatsen. Vidare forskning kopplat till Ställföreträdande lärande och Aktivitetsbaserat lärande skulle kunna användas för att optimera utbildningens resultat samt användarnas nöjdhet. En djupare analys av enkätresultatet med avseende på yrkesrollernas respektive behov skulle ytterligare kunna höja kvalitén och effektivisera utbildningarna. Studiens absolut viktigaste fynd är vikten av att chefer avsätter tid för sina medarbetare att ta del av de utbildningsmöjligheter som finns. Detta är kärnan i allt, för utan tid till utbildning spelar utbildningsmaterialets kvalitet ingen som helst roll. / This study investigates the end-user experience of education in Cosmic, a system for electronic health records, in Region Jönköping County. Training is of paramount importance for the well-being of the staff and for optimal use of the system. The purpose of the survey is to design a questionnaire that can be used for continuous improvement of the end-user training in the county.  The survey examines both quantitative and qualitative elements of a sample that is stratified based on the end‑users' professions. The survey was sent to the participants' work emails, and the responses were collected and processed using the EsMaker survey program. Ordinal scales were used as a measurement tool in many of the survey's quantitative questions, while the qualitative questions were analyzed using The constant comparative method.  The results of the study show an arbitrary attitude towards the available training material as well as towards colleagues as instructors. However, there are strong desires for organized training. A clear pattern is that users prefer training methods based on synchronous communication, as well as methods based on demonstration of the software. However, the results show that these methods should be combined with individual tasks for the best effect.  Conclusions generated by the survey are that future training efforts should involve organized training at the workplace. Further research linked to vicarious modeling and enactive learning could be used to optimize the results of the education as well as end-user satisfaction. A deeper analysis of the survey results regarding the respective needs of the professional roles could further increase the quality and streamline the education. The study's most important finding is the importance of managers to dedicate time for their employees to use the training opportunities available. This is the essence of everything, because without time for training, the quality of the educational material does not matter whatsoever. / <p>Examensarbete i vårdadministration, YH-utbildning: 20 Yh-poäng.</p>

Medication adherence in patients with asthma and chronic obstructive pulmonary disease (COPD) is notoriously low and is associated with suboptimal therapeutic outcomes. To intervene effectively, family physicians need to assess medication adherence efficiently and accurately. Otherwise, failure to detect nonadherence may further reduce patient disease control and result in unnecessary treatment escalation that can increase the risk of adverse events and lead to more complex and costly drug regimens. The overarching goal of this thesis was to investigate how the use of secondary healthcare data can be leveraged to optimize medication adherence in clinical practice. Methodological considerations to facilitate our understanding of treatment escalation in asthma using secondary healthcare data were also examined. In the first part of my doctoral research program, I led a project which aimed at developing e-MEDRESP, a novel web-based tool built from pharmacy claims data that provides to family physicians with objective and easily interpretable information on patient adherence to asthma/COPD medications. This tool was developed in collaboration with family physicians and patients using a framework inspired by user-centered design principles. As part of a feasibility study, e-MEDRESP was subsequently implemented in electronic medical records across several family medicine clinics in Quebec (346 patients, 19 physicians). Findings showed that its integration within physician workflow was feasible. Physicians reported that the tool helped to: 1) better evaluate their patients’ medication adherence; and 2) adjust prescribed therapies, with mean ± sd ratings (5-point Likert scale) of 4.8±0.7 and 4.3±0.9, respectively. A pre-post analysis did not reveal improvement in adherence among patients whose physician consulted e-MEDRESP during a medical visit. However, significant improvements in adherence for inhaled corticosteroids (Proportion of days covered (PDC): 26.4% (95% CI: 14.3-39.3%)) and long-acting muscarinic agents (PDC: 26.4% (95% CI: 12.4-40.2%)) were observed among patients whose adherence level was less than 80% in the 6-month period prior to the medical visit. The second part of this research program consisted of two studies which laid the groundwork to estimate the association between medication adherence and treatment escalation in asthma using Canadian healthcare administrative data, a phenomenon that is currently under-explored in the literature. Prior to embarking in this study, it is important to ensure that healthcare administrative databases can be used to identify asthma patients and treatment escalations in an adequate manner. First, a systematic review was conducted to obtain an overview of the available evidence supporting the validity of algorithms to identify asthma patients in healthcare administrative databases. The algorithm developed by Gershon et al. (Canadian Respiratory Journal, 2009;16(6):183-188) comprising ≥2 ambulatory medical visits or ≥1 hospitalization for asthma over two years had the best trade-off between sensitivity (84 %) and specificity (77%). Second, an operational definition of treatment escalation was developed through a Delphi study that incorporated an expert consensus process. This definition includes 7 steps and was inspired by the 2020 Global for Initiative for Asthma treatment guidelines. I plan to integrate the definitions obtained from these two studies in a future cohort study which aims to examine the association between medication adherence and treatment escalation in asthma. My research provides compelling evidence on the importance of developing and evaluating the feasibility of implementing tools which can aid physicians in assessing medication adherence in clinical practice and extends the literature on treatment escalation in asthma. / L’adhésion aux médicaments chez les patients présentant un asthme ou une maladie pulmonaire obstructive chronique (MPOC) est reconnue pour être faible. Pour intervenir efficacement, les médecins de famille doivent évaluer de manière précise l’adhésion aux médicaments. Ne pas détecter la non-adhésion peut réduire davantage la maîtrise de la maladie, entraîner une intensification non-nécessaire du traitement, mener à des schémas pharmacologiques plus complexes et coûteux et par conséquent, augmenter le risque d’événements indésirables. La présente thèse vise à approfondir les connaissances sur l'usage secondaire des données médico-administratives afin d’optimiser l’adhésion et l’usage des médicaments chez les patients atteints de maladies respiratoires chronique, au moyen d’une approche méthodologique mixte de recherche. Plusieurs questions méthodologiques cruciales concernant l’étude de l’intensification du traitement en asthme ont également été abordées. Le premier axe porte sur le développement de l’outil e-MEDRESP, qui s’appuie sur les renouvellements d’ordonnances et qui est conçu pour donner rapidement accès aux médecins de famille à une mesure objective et facilement interprétable de l’adhésion aux médicaments utilisés dans le traitement de l’asthme et de la MPOC. L’outil a été développé en collaboration avec des médecins de famille et des patients à l’aide de groupes de discussion et d’entrevues individuelles. Dans le cadre d’une étude de faisabilité, l’outil e-MEDRESP a été par la suite implanté dans les dossiers médicaux électroniques de plusieurs cliniques de médecine familiale au Québec (346 patients, 19 médecins). Les résultats ont montré que l’intégration de d’e-MEDRESP dans le flux de travail des médecins était faisable. Les médecins ont indiqué que l’outil leur a permis de : 1) mieux évaluer l’adhésion aux médicaments de leurs patients (cote moyenne et écart-type sur une échelle de Likert à 5 points [perception d’accord] de 4,8±0,7); et 2) ajuster les traitements prescrits (4,8±0,7 et 4.3±0,9). Une analyse pré-post n’a pas révélé d’amélioration au niveau de l’adhésion aux médicaments chez les patients dont le médecin a consulté e-MEDRESP lors d’une visite médicale. Toutefois, une amélioration statistiquement significative a été observée chez les patients dont le niveau d’adhésion était inférieur à 80 % au cours de la période de six mois précédant la visite et qui étaient traités par des corticostéroïdes inhalés (Proportion of days covered (PDC) = 26,4 % (IC à 95 % : 14,3-39,3 %) ou des antagonistes muscariniques à action prolongée (PDC = 26,9 % (IC à 95 % : 12,4-40,2 %)). Le deuxième axe présente des travaux préparatoires à la conduite d’une cohorte qui sera réalisée à partir de bases de données médico-administratives et qui aura comme objectif d’estimer l’association entre l’adhésion aux médicaments et l’intensification du traitement de l’asthme, une question peu explorée à ce jour. Avant de débuter une telle étude, il est important de s’assurer que les bases de données médico-administratives peuvent être utilisées pour identifier de manière adéquate les patients asthmatiques et l’intensification du traitement. Dans un premier temps, une revue systématique a été effectuée pour identifier les données probantes disponibles concernant la validité des algorithmes permettant d’identifier les patients asthmatiques dans les bases de données médico-administratives. L’algorithme qui a été développé par Gershon et coll. (Revue canadienne de pneumologie, 2009; vol. 16, no 6, p. 183-188), qui comprenait deux visites médicales ambulatoires ou une hospitalisation pour asthme sur deux ans, présentait le meilleur compromis entre la sensibilité (84 %) et la spécificité (77 %). Dans un second temps, une définition opérationnelle de l’intensification du traitement a été élaborée dans le cadre d’une étude Delphi qui incorporait un processus consensuel d’experts. Cette définition comprend sept étapes et s’inspire des lignes directrices 2020 de l'initiative mondiale de lutte contre l'asthme. Les définitions obtenues à partir de ces deux études seront intégrées dans l’étude de cohorte. Les études constituant cette thèse démontrent l’importance de développer des outils qui permettent aux médecins d’évaluer l’adhésion aux médicaments dans leur pratique clinique, en plus d’enrichir la littérature scientifique médicale sur l’intensification du traitement chez les patients asthmatiques.

Det svenska vårdsystemet står inför en rad utmaningar relaterade till de journalsystem som används idag. Sjukvårdspersonalen upplever svårigheter med systemen vilket påverkar det dagliga arbetet inom vården. Undersökningar visar att personal behöver använda sig av flera olika system för att få en helhetsbild över en patients situation, vilket försvårar en fungerande vårdkedja. Kommunikationen mellan utvecklare och sjukvården är komplex eftersom de inte är insatta i varandras arbetssätt och det saknas även enheter som ansvarar för att föra samman sjukvårdspersonalens behov på ett strukturerat sätt. Denna rapport syftar till att undersöka om och i så fall hur sjukvårdspersonalens behov och upplevelser integreras vid utveckling av journalsystem samt om detta har resulterat i att systemet uppfyller användarnas behov. Fokus för studien har varit på journalsystemet TakeCare vilket är det dominerande journalsystemet inom Region Stockholm. Arbetet som denna rapport består av utgörs delvis av en litteraturstudie för att bygga en teoretisk bakgrund om användarcentrerade produktutvecklingsprocesser, analysmetoder för behovsidentifiering, hur användarinvolvering kan bedrivas och svårigheter som kan finnas. Rapporten utgörs även av en empirisk studie bestående av semistrukturerade intervjuer där totalt sex respondenter har medverkat. Dessa respondenter utgörs av en produktägare för ett utvecklingsteam, en chef på ett förvaltningsföretag, en vårdadministrativ chef på ett akutsjukhus samt sjukvårdspersonal. Vidare så genomfördes en analys, jämförelse och diskussion gällande den information som erhållits från teorin och den empiriska studien. Resultatet av studien visar att det sker användarinvolvering under produktutvecklingen av TakeCare men inte i den omfattning som behövs för att uppfylla användarnas behov. Det framgår att detta inte beror på en ovilja till involvering, utan främst på att det finns en avsaknad av struktur i processen och kommunikation mellan utvecklare och användare. Det behov som återkommande uttrycks av användarna och som inte uppfylls är avsaknaden av tillräcklig kompatibilitet mellan journalsystemet och andra system inom vården. Avsaknad av kompatibilitet gör att användarna måste utföra dubbelt arbete vilket både har en inverkan på patientsäkerheten och tar tid från att vårda patienter. / The swedish healthcare system is facing some challenges related to the electronic medical records that are being used. The healthcare personnel are experiencing some difficulties with the systems, which affects their daily work in a negative aspect. Studies have shown that the personnel actively must use different systems in parallel to get a complete understanding of a patient's status. Furthermore, this makes the care system as a whole more complicated and inadequate.The communication between developers and healthcare can be seen as a complex process since they do not have an complete understanding of each others ways of working. Also, units for bringing together user needs in a structured manner does not exist. This study aims to examine if, and if so, how the needs of healthcare personnel are being involved in the development process of electronic medical records and if this has resulted in a more user adaptive system. The study will focus on the electronic medical record named TakeCare, which is the most used electronic medical record system inside Region Stockholm. This report partly consists of a literature study that aims to establish a theoretical background focusing on user-centered processes of product development, methods for analysing user needs, how user involvement can be conducted and what kind of difficulties that can be identified. The report also consists of an empirical study with focus on semi structured interviews with six different respondents. These respondents are both healthcare personnel, a product owner for a development team, a chief from a company that specializes in managing the electronic medical record TakeCare and a chief specialized in administrative healthcare. Furthermore, an analysis, a comparison and a discussion were followed out concerning the information gained from the theory and empirical study. The results from the study shows that user involvement during the product development process of TakeCare exists, but not to an enough extent that fulfills the user needs. This is not caused by unwillingness to adapt user involvement in the process, but a lack of structure and inadequate communication between developers and users. One particular user need that repeatedly has been expressed by the healthcare personnel, but not been fulfilled, is the lack of software compatibility between the electronic medical record and other electronic systems within the healthcare sector. The lack of software compatibility have resulted in that the users having to perform the same task repetitively, which has an impact on patient safety but also results in reduced time spent on the patients.

<p>Canadian primary care practices lag behind their counterparts in the United States and Europe in adopting Electronic Medical Record (EMR) systems to facilitate care. Although there is a considerable volume of cross-national conceptual literature focused on system design and barriers to adoption, there is little in the way of research on the unique problems faced by Canadian physicians within the publicly financed and privately provided system of healthcare delivery. This study uses a survey of Canadian physicians to investigate differences in perceptions of EMR value between two groups who have implemented these systems: “small practice” physicians, i.e. those with a maximum of 2 full-time physicians and “large practice” physicians, or those with three or more full-time physicians. A Mann-Whitney U Test conducted on survey item responses of the two groups finds that “small practice” physicians feel significantly less positive about EMRs with regards to ease of use, time savings and effective patient management.</p> / Master of Science (MSc)

<p>Chronic low back pain is the second most prevalent chronic condition in Canadian primary care settings. The treatment and diagnosis of chronic pain is challenging for primary care clinicians. Their main challenges are lack of knowledge and their approach toward assessing and treating pain. Evidence based guidelines have been developed for neuropathic pain and low back pain.</p> <p>CDSSs for chronic diseases are becoming popular in primary care settings as a mean to implement CPGs. A CDSS prototype for diagnosis and treatment of chronic, non-cancer pain in primary care was developed at McMaster University. It is evident that poor usability can hinder the uptake of health information technologies.</p> <p>The objective of this study was to test the usability of Pain Assistant using think aloud protocols with SUS scores in 2 iterations. In this study 13 primary care providers including family physicians, nurse practitioners and residents used Pain Assistant to complete 3 different patient case scenarios. Participants were asked to comment on both barriers and facilitators of usability of Pain Assistant. Additionally time to complete patient case scenarios was calculated for each participant. A comparison questionnaire gathered user preference between introducing CPGs in paper format and computerized decision support system.</p> <p>This study showed that iterative usability testing of the Pain Assistant with participation of real-end users has the potential to uncover usability issues of the Pain Assistant. Problems of user interface were the main usability barrier in first testing iteration following by problems of content. Changes were made to system design for second round based on the issues came up in the first iteration. However, because of time constrains not all the changes were implemented for second round of testing. Most of the refinements were to resolve user interface issues. In the second iteration, the problems with the content of Pain Assistant were the major barrier. The changes to the system design were successful in resolving user interface problems since the changed issues did not come up again in second round. Pain Assistant had an above the average usability score however no significant changes seen in SUS score. The time needed to complete tasks remained identical in both iterations. In addition, participants preferred to have CPGs in electronic formats than paper. Further study after implementing all the system changes needed to determine the effectiveness of system refinements.</p> / Master of Science (MSc)

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

Dans l’espoir d'améliorer l'efficacité, l’efficience, la qualité et la sécurité des soins de santé, la plupart des pays investissent dans l’informatisation de leur système de santé. Malgré l’octroi de ressources substantielles, les projets d'implantation d’un Dossier médical électronique (DME) font parfois l’objet d’une résistance importante de la part des utilisateurs au moment de leur implantation sur le terrain. Pour expliquer l’adoption d’un DME par les professionnels de la santé, plusieurs modèles théoriques ont été développés et appliqués. Une diversité de facteurs agissant à différents niveaux (individuel, organisationnel et liés à la technologie elle-même) a ainsi été identifiée. L’objectif de cette recherche est d’approfondir les connaissances empiriques quant aux facteurs influençant l’utilisation du DME chez les professionnels de la santé. Le devis de recherche repose sur une étude de cas unique avec douze entrevues et une observation non participante réalisées un an suite au lancement du processus d’implantation d’un DME auprès d’un groupe de médecine famille (GMF) au sein du Centre de santé et de services sociaux du Sud-Ouest-Verdun (Montréal, Canada). Dans le cadre de cette étude, l’analyse a permis l’identification de facilitateurs et de barrières influençant l’adoption du DME. Les facilitateurs étaient l’utilité perçue, la décision du GMF d’implanter le DME, le support de la direction ainsi que la présence de champions et de superutilisateurs. Les barrières les plus importantes étaient l’impact négatif sur le travail clinique, la fragmentation de l’information dans le DME ainsi que les problèmes liés à l’infrastructure technique. Cette connaissance permettra d’alimenter des stratégies visant à mieux répondre aux défis suscités par l’implantation du dossier médical électronique. / With the hope of improving the efficiency, effectiveness, quality, and safety of health care, most countries have made or are making investments to computerize their health systems. Despite the allocation of huge resources, the implementation of electronic medical records (EMR) has experienced significant resistance by end-users. Several theoretical models have been used to explain the adoption of an EMR by health care professionals, and a variety of factors acting on different levels have been identified: individual, organizational and related to the technology itself. The objective of this research is to deepen the level of knowledge about the factors influencing the adoption of EMRs by health professionals. This research is a single case study with nine interviews and one non-participant observation during the one-year period following the completion of the EMR-KinLogix implementation process in the Family Physician Group that is a part of the Health and Social Service Center Southwest Verdun (Montreal, Canada). The analysis identified facilitators and barriers to adoption. Facilitators were perceived usefulness, the decision of the family physician group to implement the EMR, managerial support, and the presence of champions and super users. The most important barriers were negative impact on clinical work, the fragmentation of information in the EMR and the problems of technical infrastructure. This knowledge will contribute to the challenge of outlining strategies for successful implementation of electronic medical records.

No description available.