Users’ Needs and Expectations of Electronic Medical Record Systems in Family Medicine Residence Settings George Demiris a , Karen L. Courtney a , Steven E. Waldren b a University of Missouri-Columbia, Missouri, USA b Center for Health Information Technology, American Academy of Family Physicians, USA Abstract While physician informational needs have been examined in the literature, rarely do the findings have the specificity required to drive development of Electronic Medical Records (EMRs) features. Using Delphi methodology, a comprehensive list of desirable, ranked EMR features was developed for physician residency practices. The identified EMR features and implications for system development are explored in this paper. Keywords: Medical Record Systems; Computerized; Internship and Residency; Delphi Technique; Medical Informatics 1. Introduction Informational needs of physicians have been studied in the scientific literature [1,2]. Many of these studies present needs at a more abstract or high conceptual level. What is lacking in the literature is an understanding of these needs at an “implementable” level. An implementable level is defined as the granularity or degree of detail sufficient for the developer of an Electronic Medical Record (EMR) system to devise a specification to meet that need. For example, stating that a user’s need is to communicate with other users does not provide information at an implementable level. The developer must still decide whether this communication should take place in real-time or in an asynchronous matter and whether it may be text or voice based. In contrast, the need for secure messaging would be a possible implementable need; as the developer can infer that the communication will be text-based and asynchronous. Partly responsible for this lack of design directives at this level, is the difficulty of defining and assessing users’ needs and change over time. As individual physicians practice, their informational needs change, and medicine itself is constantly changing by introduction of new information. Another confounding factor is the heterogeneity of physicians. The needs of a primary care physician are not the same as those of a specialist. In addition, the practice setting can affect need, such as urban vs. rural or private practice vs. residency practice. The varied system requirements in different medical environments have been identified as a major barrier to adoption of Electronic Medical Record (EMR) Connecting Medical Informatics and Bio-Informatics R. Engelbrecht et al. (Eds.) ENMI, 2005 65 Section 2: Computerized Patient Record