title: Primary care physicians' experiences with electronic medical records: implementation experience in community, urban, hospital, and academic family medicine.
abstract: OBJECTIVE
  To understand how remuneration and care setting affect the implementation of electronic medical records (EMRs).
  
  
  METHODS
  Semistructured interviews were used to illicit descriptions from community-based family physicians (paid on a fee-for-service basis) and from urban, hospital, and academic family physicians (remunerated via alternative payment models or sessional pay for activities pertaining to EMR implementation).
  
  
  METHODS
  Small suburban community and large urban-, hospital-, and academic-based family medicine clinics in Alberta. All participants were supported by a jurisdictional EMR certification funding mechanism.
  
  
  METHODS
  Physicians who practised in 1 or a combination of the above settings and had experience implementing and using EMRs.
  
  
  METHODS
  Purposive and maximum variation sampling was used to obtain descriptive data from key informants through individually conducted semistructured interviews. The interview guide, which was developed from key findings of our previous literature review, was used in a previous study of community-based family physicians on this same topic. Field notes were analyzed to generate themes through a comparative immersion approach.
  
  
  RESULTS
  Physicians in urban, hospital, and academic settings leverage professional working relationships to investigate EMRs, a resource not available to community physicians. Physicians in urban, hospital, and academic settings work in larger interdisciplinary teams with a greater need for interdisciplinary care coordination, EMR training, and technical support. These practices were able to support the cost of project management or technical support resources. These physicians followed a planned system rollout approach compared with community physicians who installed their systems quickly and required users to transition to the new system immediately. Electronic medical records did not increase, or decrease, patient throughput. Physicians developed ways of including patients in the note-taking process.
  
  
  CONCLUSIONS
  We studied physicians' procurement approaches under various payment models. Our findings do not suggest that one remuneration approach supports EMR adoption any more than another. Rather, this study suggests that stronger physician professional networks used in information gathering, more complete training, and in-house technical support might be more influential than remuneration in facilitating the EMR adoption experience.
authors.affiliation: Sherwood Park Primary Care Network, Unit 4, 9 Chippewa Rd, Sherwood Park, Alberta T8A 6J7. davel@sherwoodparkpcn.com
authors.forename: Dave
authors.initials: D
authors.lastname: Ludwick
authors.forename: Donna
authors.initials: D
authors.lastname: Manca
authors.forename: John
authors.initials: J
authors.lastname: Doucette
mesh_terms: D000046:Academic Medical Centers; D057286:Electronic Health Records / Q000191:economics / Q000639:trends; D005194:Family Practice; D006284:Health Plan Implementation; D006764:Hospitals, Community; D006786:Hospitals, Urban; D006801:Humans; D007400:Interprofessional Relations; D010821:Physicians, Family; D011320:Primary Health Care