Researchers: Esther Brainin¹, Yaron Mushkat², Mira Edri-Maram², Ayala Mordechai-Machnes², Ella Ofir³

Background: The aim of the current study was to explore the challenges and opportunities in (EMR) implementation and its impact on work practices and routines among the medical staff of two hospitals in Israel. Since EMR is a technology that is constantly changing, and can be tailored to users’ needs, the study was based on the the sociomaterial approach, which views users and technology as 'mutually dependent ensembles' that influence and are influenced by each other, reciprocally.

Objectives: (a) To map the impact of the implementation of EMR on different professional groups; (b) To map work routine changes instigated by various professional groups in response to the integration of the EMR technology; (c) to examine the actual effects of EMR integration on the work routines of different professional groups providing medical services; (d) to explore professional groups ' perceptions of EMR, as either an advantage or a burden, and describe their assessment of the added value afforded by the changes resulting from the EMR integration.

Method: Mixed method study based on 170 observations in five different settings of routine clinical care, 81 in-dept interviews with physicians and nurses, and surveys completed by 280 physicians, 330 nurses, 98 para-medical staff, and 83 supervisors and managers of these professional groups.

Findings: The observation findings revealed that there are inconsistencies in the ways in which Chameleon is used. Interviews and surveys revealed that alongside high satisfaction from the data integration, holistic view of patient records, and printed information, staff members complain about prolonged documentation time, excess of information and interference with patient-staff interactions and the lack of modification options.

Conclusions: There are differences within the professional groups in fulfilling Chameleon’ potential and its customization is very slow. These differences inhibit the ability of Clalit to take advantage of Chameleon’s affordances to achieve evidence-based medicine.

Recommendations: Accreditation of EMR systems are just the beginning of the implementation processes. With systems that are constantly evolving, budget allocation for intense upgrading of the system and setting advanced goals to managers related to the use of Chameleon are needed to fulfil its affordances.

Research end date: 09/2020