Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices

Area of Science:

• Health Informatics
• Medical Practice Management
• Technology Adoption

Background:

• Electronic medical record (EMR) systems have seen widespread adoption, yet physician proficiency often plateaus.
• Previous research has noted this 'ceiling effect' but lacked in-depth analysis of its underlying causes.
• This study introduces the concept of a 'tiered ceiling effect' in EMR system usage.

Purpose of the Study:

• To investigate the factors contributing to the stagnation of physician progress in using electronic medical record (EMR) systems.
• To explain the phenomenon of the 'tiered ceiling effect' in the context of EMR assimilation.
• To provide a holistic view of technological innovation in primary care settings.

Main Methods:

• Conducted in-depth case studies in three Canadian primary care practices with established EMR use (3+ years).
• Performed 37 semi-structured interviews with physicians, nurses, secretaries, and administrative managers.
• Utilized abductive reasoning, combining case data with conceptual insights from observations and documents.

Main Results:

• Confirmed a ceiling effect in all three studied clinics, identifying specific hindering conditions.
• Clinics prioritized operational efficiency, leading to the adoption of non-optimal EMR systems.
• Physician training focused on basic functions, and knowledge was primarily vendor-driven (know-what), neglecting know-why and know-how.

Conclusions:

• Limited learning, satisficing behaviors, and organizational inertia contribute significantly to the EMR ceiling effect.
• Understanding these factors is crucial for improving EMR system assimilation and maximizing their potential in primary care.
• The study offers insights into the broader technological innovation process within healthcare organizations.