Implementing electronic medical records in a psychiatric hospital: A qualitative study

The objective of this study is to examine health care professionals' opinions of the critical events (opportunities and barriers) surrounding EMR implementation in a French teaching psychiatric hospital. This qualitative study was based on semi-structured interviews with 115 health care professionals: 16 psychiatrists, 84 nurses, six psychologists or social assistants and nine secretaries or administrative professionals. Interviews were thematically analysed. Most responders (96%) used EMR. Among these EMR users, 70% perceived EMR positively. Concerning the opportunities from implementing an EMR, the most represented theme was "the improved access to medical record information" (75%), followed by "the strategy to guarantee the adhesion of professionals and the use of EMR" (69%), and "the technological performances of EMR" (49%). Concerning the barriers to implementation, four themes emerged, as follows: "the workflow and efficiency decrease" (73%), "the triangulation of the patient-professional relationship" (47%), "the information sharing and confidentiality" (32%), and "the ambiguity of EMR" (26%), which answers both to the production of care and to an economic issue. In conclusion, EMR implementation involved several critical components, and the strategy of implementation is particularly important. Implementing an EMR should be considered a continuous process, and the principle and theory of continuous quality improvement appears pertinent for addressing this problem.