How Do Users of Modern EHR Perceive the Usability, User Resistance and Productivity Kristian Malm-Nicolaisen ab , Asbjørn J. Fagerlund a , Rune Pedersen ab a Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway b UIT – The Arctic University of Norway, Telemedicine and e-health research group, Tromsø, Norway Abstract The Electronic Health Record (EHR) has been a principal component in transforming healthcare from traditional pen- and-paper documentation procedures to highly digitalized and interoperable environments. Implementation of EHR is complicated, and success is dependent on the users accepting and utilizing the system to its potential. The present qualitative multi-center study investigated health professionals perceived system usability, user resistance and productivity five to eight years after implementation of a modern EHR, across three European cites. Data was collected with semi-structured interviews with experienced health professionals that had work experience before and after implementation of the EHR. Overall, the respondents considered their EHR to have good usability, reported a low degree of user resistance, and were ambiguous on how the EHR affected their perceived workload at the present, but retrospectively reported that the road towards the present state of satisfaction was not without hurdles. Keywords: (Electronic Health Records) (Health Care Quality, Access, and Evaluation) (Implementation Science) Introduction Over the last 3 decades, healthcare organizations, healthcare professionals and patients, have witnessed a digital transfor- mation of how health and care services are organized, provided and planned. There has been a change from paper-based and manual processes, towards electronic and web-based services. The introduction of the Electronic Health Record (EHR) and digitalization of patient data has been principal in this transfor- mation. However, adoption and utilization of EHRs has been slow despite policies and financial incentives [10], and the po- tential for increased safety and productivity remains largely un- realized [13; 26]. In addition, many EHR implementations fails to deliver expected effects due to insufficient socio-technical understanding [4], inadequate organizational readiness [18], improper implementation methods [26], and user reluctance to adopt new technology [10]. To expand on the knowledge on how clinicians experience modern EHR, this study analyzes in- terview data addressing clinicians’ experiences and perception of EHR impact on three commonly applied variables for EHR implementation investigation: perceived system usability, user resistance and experienced productivity for clinicians. The cli- nicians’ present perception, as well as retrospective experience, are investigated to shed light on the perspective of users that was employed throughout the implementation process and have had a modern EHR at disposal for minimum five years. The main objectives for this study are to investigate the following aspects of the user perspective at hospitals that implemented a new EHR 5-10 years ago. Research questions are i) How do clinicians perceive the usefulness their EHR? ii) Did the clini- cians experience user resistance or reluctance towards the EHR previously or at the present? And iii) How do the use of a mod- ern EHR affect perceived workload and productivity? Methods This study was a qualitative multicenter study that employed semi structured interviews for data capture and framework the- ory for data analysis. The informants recruited were health pro- fessionals from three different hospitals in three different Euro- pean countries. Locations The informants in this study were six tenured health profession- als at three different hospitals in Europe. The hospitals were chosen on the criteria that they within the last five to ten years had a large-scale implementation of an EHR. Three hospitals were identified as relevant for the study. Informants To recruit health professionals, we contacted the management of the hospitals of interest and presented our wish to get an in- troduction to the EHR system and to interview knowledgeable health professionals with relevant experiences from the imple- mentation. The health professionals that volunteered to partici- pate as informants had been working at the hospital since the implementation of the EHR or longer, and either had regular clinical contact with patients or supervised such contact. The included informants in this study were assumed to be knowl- edgeable, and interviews were designed to be thematically fo- cused, resulting in saturation being achieved with a relatively low number of informants. The hospitals suggested a schedule for the interviews and recruited the informants based on our re- quest. Ethics Written informed consent was obtained from the informants prior to the interviews. The study did not require approval from the regional ethics committee (REK), according to the Norwe- gian Act on Medical and Health Research §2 and 4§. In order to retain the anonymity of the informants, information that could associate a specific informant to a specific site were omit- ted during the data analysis and in the subsequent manuscript. Five Years or More After Implementation? MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation P. Otero et al. (Eds.) © 2022 International Medical Informatics Association (IMIA) and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0). doi:10.3233/SHTI220195 829