Connecting Medical Records: An Evaluation of Benefits and Challenges for Primary Care Practices

Deborah Ruth Compeau, Amanda Terry


Background: Implementation of systems to support health information sharing has lagged other areas of healthcare IT, yet offers a strong possibility for benefit.  Clinical acceptance is a key limiting factor in health IT adoption.

Objectives:  To assess the benefits and challenges experienced by clinicians using a custom-developed health information exchange system, and to show how perceptions of benefits and challenges influence perceptions of productivity and care-related outcomes.

Methods: We used a mixed methods design with two phases. First, we conducted interviews with stakeholders who were familiar with the health information exchange system to inform the development of a measure of benefits and challenges of the use of this system. Second, using this measure we conducted a survey of current and former users of the health information exchange system using a modified Dillman method.

Results: 105 current and former users completed the survey. The results showed information quality, ease of completing tasks and clinical process improvement as key benefits that reduced workload and improved patient care.  Challenges related to system reliability, quality of reports and service quality increased workload and decreased impact on care, though the effect of the challenges was smaller than that of the benefits.

Conclusions:  Even very limited health information exchange capabilities can improve outcomes for primary care users.  Improving perceptions of benefits may be even more important the removing challenges to use, though it is likely that a threshold of quality must be achieved for this to be true.


computerized medical record; primary care; information system

Full Text:



Abraham C, Junglas I. From cacophony to harmony: A case study about the IS implementation process as an opportunity for organizational transformation at Sentara Healthcare. J Strateg Inf Syst. 2011;20(2):177-197. doi:10.1016/j.jsis.2011.03.005.

Jensen TB. Design principles for achieving integrated healthcare information systems. Health Informatics J. 2013;19(1):29-45. doi:10.1177/1460458212448890.

Cho S, Mathiassen L, Nilsson A. Contextual dynamics during health information systems implementation: An event-based actor-network approach. Eur J Inf Syst. 2008;17:614-630.

Lapointe L, Rivard S. A triple take on information system implementation. Organ Sci. 2007;18(1):89-107. Accessed April 29, 2013.

Agarwal R, Gao G, DesRoches C, Jha a. K. Research Commentary--The Digital Transformation of Healthcare: Current Status and the Road Ahead. Inf Syst Res. 2010;21(4):796-809. doi:10.1287/isre.1100.0327.

Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010;10(1):231. doi:10.1186/1472-6963-10-231.

Holden RJ, Karsh BT. The technology acceptance model: Its past and its future in health care. J Biomed Inform. 2010;43(1):159-172.

Kijsanayotin B, Pannarunothai S, Speedie SM. Factors influencing health information technology adoption in Thailand’s community health centers: Applying the UTAUT model. Int J Med Inform. 2009;78(6):404-416. doi:10.1016/j.ijmedinf.2008.12.005.

Li J, Talaei-Khoei A, Seale H, Ray P, Macintyre CR. Health care provider adoption of eHealth: Systematic literature review. Interact J Med Res. 2013;2(1):e7. doi:10.2196/ijmr.2468.

Venkatesh V, Sykes T, Zhang X. “Just what the doctor ordered”: a revised UTAUT for EMR system adoption and use by doctors. In: Proceedings of the 44th Hawaii International Conference on System Sciences. Vol Koloa, Kauai: IEEE Computer Society; 2011:1-10.

Bhattacherjee A, Hikmet N. Physicians’ resistance toward healthcare information technology: a theoretical model and empirical test. Eur J Inf Syst. 2007;16(6):725-737. doi:10.1057/palgrave.ejis.3000717.

Cenfetelli R. Inhibitors and enablers as dual factor concepts in technology usage. J Assoc Inf Syst. 2004;5(11):472-492. Accessed March 10, 2014.

Lau F, Hagens S, Muttitt S. Framework for Health Information Systems in Canada. 2009;10(1):112-118.

Lau F, Price M, Keshavjee K. From benefits evaluation to clinical adoption: making sense of health information system success in Canada. Healthc Q. 2011;14(1):39-45.

VanDerMeijden MJ, Tange HJ, Troost J, Hasman A. Determinants of success of inpatient clinical information systems: a literature review. J Am Med Informatics Assoc. 2003;10(3):235-243. Accessed April 29, 2013.

Schoen C, Osborn R. The commonwealth fund 2012 international health policy survey of primary care physicians. In: 2012 International Symposium on Health Care Policy. Vol ; 2012:33 pages.

Cresswell JW, Plano VL. Designing and Conducting Mixed Methods Research. Vol 2nd editio. Thousand Oaks, CA: Sage Publications; 2011.

Dillman DA. Mail and Internet Surveys: The Tailored Design Method. Vol 2nd ed. New York: John Wiley and Sons; 2000.

Law KS, Wong CS, Mobley WH. Towards a taxonomy of multidimensional constructs. Acad Manag Rev. 1998;23(4):741-755.

Bhattacherjee A, Hikmet N. Physicians’ resistance toward healthcare information technology: A theoretical model and empirical test. Eur J Inf Syst. 2007;16(6):725-737.

Ringle CM, Wende S, Will A. SmartPLS. 2005.

Wetzels M, Odekerken-Schroder G, van Oppen C. Using PLS path modeling for assessing hierarchical construct models: Guidelines and empirical illustration. MIS Q. 2009;33(1):177-195. Accessed February 25, 2014.

Armstrong JS, Overton TS. Estimating nonresponse bias in mail surveys. J Mark Res. 1977;14(3):396-402.

Delone W, McLean E. The DeLone and McLean model of information systems success: a ten-year update. J Manag Inf Syst. 2003;19(4):9-30. Accessed March 26, 2014.

Chatterjee S, Chakraborty S, Sarker S, Sarker S, Lau FY. Examining the success factors for mobile work in healthcare: A deductive study. Decis Support Syst. 2009;46(3):620-633. doi:10.1016/j.dss.2008.11.003.

Devaraj S, Kohli R. Performance impacts of information technology: is actual usage the missing link? Manage Sci. 2003;49(3):273-289. Accessed April 21, 2014.

Goh J, Gao G, Agarwal R. Evolving work routines: adaptive routinization of information technology in healthcare. Inf Syst Res. 2011;22(3):1-51. Accessed April 21, 2014.

Lau F, Hagens S, Muttitt S. A proposed benefits evaluation framework for health information systems in Canada. Healthc Q. 2007;10(1):112-118. Accessed April 28, 2013.



  • There are currently no refbacks.

This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT