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Multi-level analysis of electronic health record adoption by health care professionals: A study protocol

Marie-Pierre Gagnon12*, Mathieu Ouimet13, Gaston Godin2, Michel Rousseau4, Michel Labrecque14, Yvan Leduc4 and Anis Ben Abdeljelil1

Author Affiliations

1 Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada

2 Faculty of Nursing Sciences, Université Laval, Québec, Canada

3 Department of Political Science, Université Laval, Québec, Canada

4 Department of Family Medicine, Faculty of Medicine, Université Laval, Québec, Canada

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Implementation Science 2010, 5:30  doi:10.1186/1748-5908-5-30

Published: 23 April 2010



The electronic health record (EHR) is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors.


A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada). At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary.


The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings.


These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition, this research constitutes a major contribution to the field of knowledge transfer and implementation science.