Are we putting the cart before the horse? A microcosm of intended and unintended outcomes of electronic medical record implementation

Leaders in health care are calling for the implementation of electronic medical records (EMR) systems to help alleviate high costs of care delivery, high error rates, and uneven access to care. However, many of these leaders seem to be overlooking unintended outcomes of EMR implementation. Specifically, they may be overlooking the critical role physician beliefs and relationships play in the use of EMRs and in generating both intended and unintended outcomes. We studied a microcosm of the health care system through a qualitative field study examining EMR use in four clinics operating within a multi-specialty medical organization. We found that beliefs held by physicians about medical practice and the patterns of relationships in clinics influence EMR use behaviors in both expected and unexpected ways. Our contribution is to call attention to unintended outcomes of EMR implementation and to suggest that EMRs can be used as artifacts for learning.