title: Understanding health care providers' reluctance to adopt a national electronic patient record: an empirical and legal analysis.
abstract: BACKGROUND
  Several countries are implementing a national electronic patient record (n-EPR). Despite the assumed positive effects of n-EPRs on the efficiency, continuity, safety and quality of care, their overall adoption remains low and meets resistance from involved parties. The implementation of the Dutch n-EPR also raised considerable controversy, which eventually caused the Dutch government to stop its contribution to the national infrastructure.
  
  
  OBJECTIVE
  To explain Dutch health care providers' reluctance in adopting the n-EPR, we investigated their perceptions of problems associated with the n-EPR and their legal position regarding then-EPR. We hereby aim to provide suggestions about approaches that could promote successful implementation.
  
  
  METHODS
  The study consisted of two parts. The empirical part of the study was conducted in three health care settings: acute care, diabetes care, and ambulatory mental health care. Two health care organisations were included per setting. Between January and June 2010, 17 stakeholders working in these organisations were interviewed to investigate health care providers' perceptions of problems associated with the n-EPR. In the legal part of the study, legal documents were analysed to study health care providers' legal position regarding the n-EPR and any associated problems.
  
  
  RESULTS
  The respondents expressed concerns about the confidentiality and safety of information exchange and the reliability and quality of patient data in the n-EPR, and indicated that their liability in case of medical errors was not sufficiently clear. The perceived problems could partly be attributed to legal uncertainties.
  
  
  CONCLUSIONS
  It is recommended to start the implementation of an n-EPR in limited geographical areas. This will allow health care providers to experience benefits of electronic information exchange before being asked to participate in information exchange at a larger scale. The problems that health care providers perceive in the n-EPR should be minimised. Legislation underlying the n-EPR should provide sufficient clarity about health care professionals' responsibilities and liabilities.
authors.affiliation: NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands. m.zwaanswijk@nivel.nl
authors.forename: M
authors.initials: M
authors.lastname: Zwaanswijk
authors.forename: M C
authors.initials: MC
authors.lastname: Ploem
authors.forename: F J
authors.initials: FJ
authors.lastname: Wiesman
authors.forename: R A
authors.initials: RA
authors.lastname: Verheij
authors.forename: R D
authors.initials: RD
authors.lastname: Friele
authors.forename: J K M
authors.initials: JK
authors.lastname: Gevers
mesh_terms: D001291:Attitude of Health Personnel; D016494:Computer Security / Q000331:legislation & jurisprudence; D003219:Confidentiality / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D016365:Liability, Legal; D008297:Male; D016347:Medical Records Systems, Computerized; D009426:Netherlands