and allows a consultant to draw pictures in a similar way to they
are used to drawing them with paper records. A picture of a paper
record with such a drawing is shown in (Fig. 5).
An additional technical feature of the system that was useful for
winning over users was an integrated paper backup system that allows
the EMR system to be used in conjunction with the paper record
system at the hospital. This not only made the system more
reliable, but it also allowed the hospital to make use of the EMR
system optional during clinical work. This enabled the hospital to
use the stepwise implementation process that is described later.
4.4. Critical social system features
In addition to technical features, targeted social change was an
important part of overall system. The implementation process was
developed during meetings containing members from all the different
departments after system development had finished at the
end of 2006. The process included organizing training and awareness
programs, and technical support for both health staff and
administrative staff. Demo-CDs were distributed to users that allow
them to practice using the system at home and, for example,
learn the interface and templates used. Users were also given the
option of practicing online via the hospital web page. The implementation
process also considered the issue of some users being
inexperienced using computers. One of the managers explained
that,
‘‘First we selected a group of users who are fond of technology,
and use computers more often. We trained them first. They
learned the system very fast and were trainers for other people’’.
(Manager_1 Nov. 2007.)
4.4.1. Stepwise Implementation
Another implementation tactic was the employment of a stepwise
implementation process. The goal of this process was to
slowly introduce the EMR system so that the clinical staff would
have a considerable amount of time to get used to the system before
using it during all clinical work.