112 Chapter 8 surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. This multivariate analysis demonstrated that hypothesis 1, EMR maturity is associated with a shorter LOS on average of colorectal cancer surgery patients, is supported by our findings. All other hypotheses were not confirmed. CONCLUSIONS OF SUBQUESTION 2 (CHAPTERS 3, 4 AND 5): The three quantitative sub-studies showed little (LOS) or no association between maturity and quality of care. This led us to the third subquestion to inquire about the reflections of the medical specialists, as a key player, of the participating hospitals on the results found. Subquestion 3. The relationship between EMR use and the influencing factors according to the medical specialist - Main findings chapter 6. To answer this research subquestion, a qualitative research study was performed. A qualitative design was considered appropriate for this question, as the primary objective was to explore more in-depth perceptions of factors and processes related to a more complex system, including social and technical components 8. The medical specialists predominantly identified barriers. When the answers received, were categorized using a previously published taxonomy 9 , the medical specialist considered technical factors the most significant barriers for EMR use to have a positive effect on quality of care, followed by the suboptimal change processes surrounding implementation. On the positive side, they also identified potential technical facilitators, particularly in the assured availability of information to all health professionals involved in patient care. The overall picture shows that respondents prefer digital over the old paper records. The fact that involved health professionals can access the patient data at any time they need it, is considered important. However, at the same time, respondents 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, respondents do see the potential, but a way to record coded information
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