89 Medical Specialists’ Perspectives on the Influence of Electronic Medical Record Use events (AE), preventable AEs, AE caused by medication, the number of readmissions (RA) and the length of stay (LOS) as measured in the NIVEL study 8. Our research team did not understand why a better EMRAM score does not lead to a better quality of care. We had the impression that two intervening aspects play a role: The implementation process itself and the role of medical specialists. We got this impression because of several publications about both aspects. The first of these is a paper written by Adler-Milstein and colleagues 9, which emphasizes the importance of the implementation process of more mature IT systems for reaching higher quality. Recent studies suggest that unsuccessful implementation of EMR systems could be due to poorly designed EMR systems, poor use of EMRs by clinicians, or social organisational aspects such as goal conflicts, lack of time, or lack of support from colleagues 10. The second factor is the role of the medical specialist 11,12. Previous studies show it is an important factor in the ‘adoption and use’ 6 of EMR systems in hospitals. Medical specialists are a main frontline user-group of EMR systems. In addition, whether or not they support and effectively use EMR systems will greatly influence other usergroups in a medical institution, such as nurses, pharmacists, and administrative staff. To optimise EMR use, it is therefore essential to understand what physicians perceive to be key aspects that either support or hinder the use of EMR systems which can positively impact medical treatment and care. To substantiate our ideas about not finding a relation between the EMRAM score and quality of care, we started this study with the following open research question: ‘Which positive or negative aspects influence, the relation between EMR use and the quality of medical care, according to medical specialists?’ METHODS To answer the research question, 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 13. In the period 2012-2015, the development of EMR use in 72 Dutch hospitals was measured using the so-called EMRAM score 14. The hospitals that were measured twice in the research period and did not work with nursing documentation in the EMR nor with 6
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