98 Chapter 6 The aspect ‘Change Process’ In table 8, illustrative quotes for the factor ‘Change Process’ are summarized. According to the medical specialists, several preconditions for success must be met before the successful introduction of EMRs in their hospital. There is some doubt, for example as to whether the supplier of EMRs is willing to create links to other parts of the IT- systems. However, this runs counter to market forces. Moreover, participants mention that governmental institutions often also still require medical specialists to use paper. A central theme for almost all interviewed medical specialists is the coded or non-coded recording of obtained information. They generally realize that encoding the medical record is a prerequisite for getting help from the EMR-system based on so-called evidence-based material. Several hospitals have initially started out with the recording of this information by medical specialists but have later abolished this system because the medical specialist refused to work with it. Table 8 - The Change Process - Illustrative quotes from participants. The Change Process Quote Support from organisational culture “There is too little attention for resistance in medical specialists due to, for example, time pressure.” (participant 8) “Before, medical specialists were individual, had their own working methods. By now, a technological revolution has taken place (paper records are now electronic records). But people do not want to change (95%). They have to get out of their comfort zone. You have to invest in that. Now: medical specialists’ approach EMR as if it were paper.” (participant 10) “The problem is that hospitals are not IT-minded. Hospitals are not flexible.” (participant 10) Leadership “On its own, the market will not provide properly functioning IT systems for hospitals (participant 2) “Cytostatic control by pharmacies should be done via inspection on paper.” (participant 8) “Participant sees movement from specialism-based (departments) towards disease -related. For example, department of bowel cancer with internist, MDL, oncologist, and radiologist. This has an impact on the way digitization is organized.” (participant 4) “(EMR supplier mentioned) is monopolist. Does not listen to customer.” (participant 4) Incentives “On its own, the market will not provide properly functioning IT systems for hospitals For example, the market does not benefit from the exchangeability of data. Market forces therefore do not lead to the solution.” (participant 2) “No ‘reward’ for ‘good’ use.” (participant 8) Participation “Conclusion: Letting medical specialists do coding work is undesirable, but it is necessary to enable systems to ‘offer help’ on a more advanced level. This process should be structured differently by giving supporting staff a role in it” (participant 8)
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