A new insight BMS-907351 developed after the first focus group, and the interview

questions were adapted to explore this new knowledge. It was discussed until the point reached saturation similar to the situation in other studies.17 18 Physicians in our study reported that the EMR documentation was time-consuming, due to many clicks that had to be performed, even for short documents and simple complaints. In the review of the published literature, physicians recognised the benefits of the EMR for legibility, and readily linked this to better and safer patient care outcomes. The burden and time inefficiency of data entry are seen as major disadvantages, suggesting the importance of ‘smarter’ and more intuitive data entry interfaces and perhaps voice recognition.19 This also emerged as a subtheme in our study. Participants continued to identify the important role of an EMR champion within their practice who encouraged EMR usage and was available to solve problems. Support and encouragement from a ‘champion’ has been noted in the literature as crucial throughout the

implementation process.1 20 In this study, participants mentioned that follow-up by super users and the IT team would be beneficial. Participants identified the messaging system within the EMR software as a practical, useful and important tool for enhancing efficiency within the team. Successful communication has been linked to increased patient safety and improved patient outcomes.1 The physicians in all focus groups emphasised this point. They mentioned that internal communication in the clinic through the system had saved time and improved

patient safety. Major barriers to implementation and adoption included computer literacy, training and time. There was also variability regarding the influence of prior computer knowledge on perceptions of EMR implementation. While these issues have been identified in prior studies, they remain an ongoing challenge for primary healthcare providers. Implementation and adoption of EMRs will be most successful when protected time is available to train all EMR users.17 In this study, similar concerns were raised. A recent review of studies on barriers to EMR implementation Anacetrapib found that these could be broadly categorised as concerns about costs, technical issues (including lack of interconnectivity, high complexity and lack of customisability), lack of time, psychological factors such as lack of belief in the EMR, social factors such as lack of support from colleagues, and legal issues such as concerns over privacy and security.21 22 Complexity, interconnectivity and time factors also emerged from the current study. Limitations The present study was limited in several ways. First, it included only physicians despite the importance of understanding nurses, pharmacists and other healthcare professionals’ beliefs about using the EMR.