title: Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.
abstract: BACKGROUND
  Recent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context.
  
  
  METHODS
  Case study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT.
  
  
  RESULTS
  Qualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central 'actor' within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal.
  
  
  CONCLUSIONS
  The paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.
authors.affiliation: Department of Policy Analysis and Public Management, Bocconi University, Via Roentgen, 1, 20136, Milan, Italy. maria.cucciniello@unibocconi.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Cucciniello
authors.affiliation: IPSAR, University of Edinburgh Business School, Edinburgh, Scotland, UK. Irvine.Lapsley@ed.ac.uk.
authors.forename: Irvine
authors.initials: I
authors.lastname: Lapsley
authors.affiliation: Department of Policy Analysis and Public Management Bocconi University, Bocconi University, Milan, Italy. greta.nasi@unibocconi.it.
authors.forename: Greta
authors.initials: G
authors.lastname: Nasi
authors.affiliation: eHealth Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK. ClaudiaPagliari@ed.ac.uk.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pagliari
mesh_terms: D004059:Diffusion of Innovation; D057286:Electronic Health Records; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008962:Models, Theoretical; D019370:Observation; D036301:Qualitative Research