March 2020
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Background: Numerous publications show that Electronic Medical Record (EMR) systems may provide an important contribution to increasing the quality and effectiveness of care. There are indications that particularly the medical specialist plays an important role in the implementation of EMR systems in hospitals. Our goal in this study is to answer the question: which positive or negative factors influence, in the perception of medical specialists, the relation between the EMR use and the quality of medical care? Methods: To answer this question, a qualitative study was conducted in the period August until October 2018. Semi-structured interviews of around 90 minutes were held with twelve medical specialists of twelve different Dutch hospitals. For the analysis of the answers, we used the classification of factors that can influence the implementation of EMR systems based on a previously published taxonomy. Results: The participating interviewees were experienced medical specialists. Their experience within the hospitals concerned varies between 5 and 27 years. There is a spread across different types of hospitals and specialisms. When the answers received are categorised using a previously published taxonomy, 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. The categories ‘social’ and ‘psychological’ and ‘time’ come in at a shared third place. On the positive side, they also identified potential technical facilitators, particularly in the assured availability of information to all health professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve quality of care, but consider these capabilities currently lacking. Conclusions: In comparison with the paper record, the interviewed medical specialists consider the digitalised record a great leap forward. Every involved health professional can access the patient data if desired at any time they need it. However, in practice, real quality improvement lags behind as long as, for instance, no one uses decision support no one uses decision support, good integrated analytic tools are missing, and the organisation of care is not adapted to these new possibilities.