1. Meaningful Electronic Medical Record Use: A Survey of Family Practice Clinics
Summary of Research Study Results (Master’s Thesis)
By Bekki Tagg, BA, RN, BN, MSc
Faculty of Health Sciences
University of Lethbridge
Theoretical Framework – Innovation Implementation Model (Klein & Sorra, 1996)
Klein & Sorra’s (1996) Innovation Implementation Model was developed to assess the effectiveness of
“innovations that require the active and coordinated use of multiple organizational members to
benefit the organization” (Klein & Sorra, 1996, p. 1057).
From “The Challenge of Innovation Implementation,” by K. J. Klein & J. S. Sorra, 1996, Academy of
Management Journal, 21, p. 1056.
•Canada historically lags behind other countries in both Electronic
Medical Record (EMR) adoption and Meaningful EMR (Canadian
Medical Association, 2010; Jha, Doolan, Grandt, Scott, & Bates, 2008).
•Change process in family physician clinics is extremely difficult and
complex.
Problem
•Limited existing research into factors impacting technology implementations and
Meaningful EMR Use in family physician clinics (Lai, Lau, & Shaw, 2009).
•There is a need for a system of quality controls and usage audits to be in place (Miller &
Sim, 2004).
•Patient safety is compromised when available technology is not fully utilized (Dawes &
Chan, 2010).
•Optimal use of technology increases adherence to the most recent clinical practice
guidelines to manage proactive health screening and to manage chronic disease.
(Eichenwald Maki & Petterson, 2008).
Significance

2. Research Design – Quantitative Survey
Measures
Meaningful EMR Use Scale
Level Cumulative Capabilities
1 Traditional paper-based practice
2 Electronic reference material, but still paper charting
3 Partial use of computers at point of care for recording patient
information
4 Computer has replaced paper chart
5 Advanced clinical decision support in use, including practice level
reporting
6 Full EMR interconnected with regional / community hospitals, other
practices, labs and pharmacies for collaborative care.
(Adapted from Price, Lau & Lai, 2011)
Demographics
13 items
•Individual
•Organizational
Innovation
Implementation
(Klein & Sorra, 1996)
50 items
•Implementation Climate
•Innovation-Values Fit
•Skills
•Absence of Obstacles
•Incentives
•Commitment
•Implementation
Effectiveness
Meaningful EMR Use
(Price, Lau & Lai ,2011)
30 items
•Health Information
•Medications
•Laboratory
•Medical Imaging
•Referrals
•Decision Support
•Electronic
Communication &
Connectivity
•Patient Support
•Administrative processes
•Reporting & Population
Health Management
Convenience sample recruitment methods:
 Fax
 Paper mail
 Phone calls
 Networking
 Electronic announcements
Purpose: explore current meaningful
EMR use levels in family physician clinics
in Alberta, Canada, and to identify
statistically significant factors that
contribute to higher meaningful use.

3. Findings
Responding sample: participants n= 139, clinics n = 44
Telus -
Med-
Access
34%
Telus -
Wolf
36%
Other (7
EMRs)
30%
EMR Use Breakdown
Factors
Significantly
Correlated with
Increased
Meaningful
EMR Use
Participation in POSP
(F (2,21) = 15.31, p < 0.001)
Health zone
(F (3,21) = 5.17, p = 0.008)
- Highest level of use - Edmonton zone (M = 4.59, SD = 0.64)
Innovation-Values Fit
(r = 0.49, p ≤ 0.05, R2 = 0.24)
Innovation Implementation
(r = 0.81, p ≤ 0.01)
- Implementation Climate (r = 0.79, p ≤ 0.01, R2 = 0.62)
- Task Support, (r = 0.65, p ≤ 0.01)
- Goal Emphasis, (r = 0.53, p ≤ 0.01)
Implementation Effectiveness:
 Positively impacted by intrinsic motivation
o (r = 0.59, p ≤ 0.01),
 Not impacted by extrinsic motivation (bonuses, raises, or promotions)
o (r = 0.14, p = 0.21).
Implications and Impact
Clinics can increase their Meaningful EMR Use by participating in programs like POSP, by improving
employee access to tools, resources, and training, as well as providing clear direction about
expected technology use standards and desired outcomes.

4.  Small sample size
 Meaningful EMR Use scale items (Price, Lau,
and Lai, 2011):
o New scale - no previous reliabilities
o This data set showed low reliabilities
(α = 0.50) for 5 items:
 Electronic Communication
and Connectivity, α = 0.48
 Health Information, α = 0.45
 Patient Support, α = 0.29
 Medical Imaging, α = 0.22
 Referrals, α = 0.09
 Further research on the Meaningful EMR
Use scale (Price, Lau, and Lai, 2011) to
assess validity.
 Adjustments to the Meaningful EMR Use
scale (Price, Lau, and Lai, 2011) to
increase reliability.
 Targeted study of a group of clinics (ex.
a Primary Care Network) at several
intervals post EMR adoption or during
an improvement initiative.
Future Research AreasLimitations
Glossary:
 EMR – Electronic Medical Record
 Goal Emphasis - clear direction about expected standards and outcomes
 Health Information – a patient’s medical summary, demographics, and visit notes
 Implementation Climate - employee perceptions of the practices, procedures, and behaviors that get rewarded,
supported, and expected within their organization.
 Implementation Effectiveness - employees feel that the system is a valuable addition to the work practices of the
organization, and they choose to use the system when given the opportunity.
 Innovation Implementation Model (Klein & Sorra, 1996) - a model assessing the implementation of innovations that
require the active and coordinated use of multiple organizational members to benefit the organization.
 Innovation-Values Fit - the extent to which users feel the innovation will either foster or inhibit the fulfillment of their
values
 Meaningful EMR Use – The extent to which the different modules of an EMR system are used.
 Patient Support - support provided to patients through the distribution of handouts and test results
 POSP – Physician Office Systems Program
 Task Support - employees have the tools and resources to keep them up to date with training
References:
Canadian Medical Association. (2010). National physician survey, 2010: Provincial results by FP/GP or Other Specialist, Sex,
Age, and All Physicians: ALBERTA. Retrieved from http://nationalphysiciansurvey.ca/wp-
content/uploads/2012/09/2010-ProvAB-Q27.pdf
Dawes, M., & Chan, D. (2010). Knowing we practice good medicine: Implementing the electronic medical record in family
practice. Canadian Family Physician, 56(1), 15–16.
Eichenwald Maki, S., & Petterson, B. (2008). Using the electronic health record. Clifton Park, NY: Delmar Cengage Learning.
Jha, A. K., Doolan, D., Grandt, D., Scott, T., & Bates, D. W. (2008). The use of health information technology in seven nations.
International Journal of Medical Informatics, 77, 848–854. doi:10.1016/j.ijmedinf.2008.06.007
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Journal, 21, 1055–
1080. doi:10.5465/AMR.1996.9704071863
Lai, J. K., Lau, F., & Shaw, N. (2009). A study of information technology use and implementation of electronic medical
record systems in BC medical practices. BC Medical Journal, 51, 114–121.
Miller, R. H., & Sim, I. (2004). Physicians’ use of electronic medical records: Barriers and solutions. Health Affairs, 23, 116–126.
doi:10.1377/hlthaff.23.2.116
Price, M., Lau, F., & Lai, J. (2011). Measuring EMR adoption: A framework and case study. Electronic Healthcare, 10(1),
e25–e30.
Author contact information: Bekki.Tagg@uleth.ca
Full thesis available on the University of Lethbridge Theses Repository website–https://www.uleth.ca/dspace/handle/10133/298