title: Implementing an electronic medical record in a family medicine practice: communication, decision making, and conflict.
abstract: OBJECTIVE
  Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the financial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine office culture affect the initial implementation of an EMR.
  
  
  METHODS
  As part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data.
  
  
  RESULTS
  Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal conflicts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.
  
  
  CONCLUSIONS
  Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an office practice and without methods for bringing to the surface and addressing conflicts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs.
authors.affiliation: Department of Family Medicine, University of Medicine and Dentistry, New Jersey Medical School, Newark, NJ 07107, USA. jesse.crosson@umdnj.edu
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Crosson
authors.forename: Christine
authors.initials: C
authors.lastname: Stroebel
authors.forename: John G
authors.initials: JG
authors.lastname: Scott
authors.forename: Brian
authors.initials: B
authors.lastname: Stello
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D003142:Communication; D003657:Decision Making; D005194:Family Practice / Q000458:organization & administration*; D007400:Interprofessional Relations; D016347:Medical Records Systems, Computerized; D015279:Organizational Culture; D011216:Practice Management, Medical / Q000458:organization & administration*