abstract
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Fewer than one in four Canadian doctors use electronic medical record (EMR) systems, although almost all have some form of computer for scheduling and billing purposes. Each year in Canada, more than 1 00 million physician examinations and 500 million laboratory and radiology tests are performed, and 3 82 million prescriptions are written. These patient records are scattered and often inaccessible in doctors' offices, clinics, test centres, labs, and hospitals. To properly care for their patients, primary care practitioners must have access to all their relevant medical records. If a physician does not use an EMR system, results may be transferred by fax, telephone, or mail, causing significant delays in diagnosing problems. Even when physicians use EMR systems, incompatible systems create serious problems when a patient's records must be transferred to other settings or when coordination is required among several practitioners. This results in errors or mislaid information, unnecessary delays, duplication of effort, higher costs, and reduced quality of care. Non-adoption ofEMR systems is a highly complex problem that has not been addressed adequately in a comprehensive manner. There are many interdependent factors that influence adoption and these must be considered simultaneously. The first objective of this proposed research is therefore to develop and validate statistically a comprehensive theoretical model of EMR adoption through a national survey of physicians, to attempt to explain why private medical practices in Canada have tended to be slow in adopting electronic medical records and related systems. This paper describes that model and its basis, including the methodology that will be used to analyze the data. A second and dependent objective, arising from results from the first objective, will be to propose and evaluate potential policies that would help to improve the adoption of such systems in a manner that would support their most effective and efficient application by medical practitioners.