99 Medical Specialists’ Perspectives on the Influence of Electronic Medical Record Use DISCUSSION To answer the research question ‘which positive or negative aspects influence the relation between the EMR use and the quality of medical care, according to medical specialists’, a qualitative research study was performed. The overall picture of the relation between the extent of EMR use and the quality of medical care according to the medical specialist shows that participants prefer digital records over the old paper ones. However, at the same time, participants consider the technical systems old-fashioned compared to the systems they can access at home to book a trip or buy a book. The inability of all those involved (professional groups, boards, suppliers, politicians) to improve this situation is described openly by some participants. By and large, participants do see the potential, but a better way to record coded information still needs to be found. The lack of interconnection between the different EMRs, for example per hospital department (such as Internal Medicine and Cardiology) is also seen as an important limitation. Noteworthy is also those financial aspects are not mentioned often. This contrasts with other studies, in which ‘technical issues’ and ‘financial issues’ are mentioned in equal measure. 12 The obvious question is then whether “money plays an important role” according to the medical specialist. Finally, these systems should be able to offer support in decision making for diagnosis and treatment. 19. Participants indicated that it is necessary to fulfil some of the preconditions for success before the EMR can make a positive contribution to the hospital’s daily practice. And that is essentially the source of the medical specialist’s resistance It takes a lot of effort and time to keep the patient file up to date. The only result is a non-paper file, which they appreciate, but is ultimately not enough to motivate them. It is tempting to make encoding medical data mandatory. But without interventions in the organization this is doomed to fail, because many medical specialists are unwilling or unable to comply. In the end, inefficiently organized processes will then be automated at great cost and effort while remaining inefficient at their core. 20 So, prior to the question of how to improve the available processes comes the basic question: what can be improved? Are the available business processes principally accepted, or can the search be directed towards a change of the existing processes?21 6
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