Brief review: Adoption of electronic medical records to enhance acute pain management

  • David H. Goldstein
  • Rachel Phelan
  • Rosemary Wilson
  • Amanda Ross-White
  • Elizabeth G. VanDenKerkhof
  • John P. Penning
  • Melanie JaegerEmail author
Review Article/Brief Review



The purpose of this paper is to examine physician barriers to adopting electronic medical records (EMRs) as well as anesthesiologists’ experiences with the EMRs used by the acute pain management service at two tertiary care centres in Canada.


We first review the recent literature to determine if physician barriers to adoption are changing given the exponential growth of information technology and the evolving healthcare environment. We next report on institutional experience from two academic health sciences centres regarding the challenges they encountered over the past ten years in developing and implementing an electronic medical record system for acute pain management.

Principal findings

The key identified barriers to adoption of EMRs are financial, technological, and time constraints. These barriers are identical to those reported in a systematic review performed prior to 2009 and remain significant factors challenging implementation. These challenges were encountered during our institution’s process of adopting EMRs specific to acute pain management. In addition, our findings emphasize the importance of physician participation in the development and implementation stages of EMRs in order to incorporate their feedback and ensure the EMR system is in keeping with their workflow.


Use of EMRs will inevitably become the standard of care; however, many barriers persist to impede their implementation and adoption. These challenges to implementation can be facilitated by a corporate strategy for change that acknowledges the barriers and provides the resources for implementation. Adoption will facilitate benefits in communication, patient management, research, and improved patient safety.


Electronic Medical Record Local Area Network Electronic Medical Record System Anesthesia Information Management System Acute Pain Management 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Article de synthèse court : L’adoption du dossier médical informatisé pour améliorer la prise en charge de la douleur aiguë



L’objectif de cet article est d’examiner les réticences des médecins à l’adoption du dossier médical informatisé (DMI) ainsi que l’expérience des anesthésiologistes avec les DMI utilisés au service de prise en charge de la douleur aiguë de deux centres tertiaires canadiens.


Nous passons tout d’abord en revue la littérature récente afin de déterminer si les réticences des médecins à l’adoption évoluent étant donné la croissance exponentielle des technologies de l’information et l’évolution de l’environnement des soins de santé. Par la suite, nous rapportons l’expérience institutionnelle de deux centres universitaires des sciences de la santé et les défis qu’ils ont rencontrés au cours des dix dernières années en matière de mise au point et de mise en œuvre d’un système de dossier médical informatisé pour la prise en charge de la douleur aiguë.

Constatations principales

Les principaux obstacles à l’adoption du DMI que nous avons identifiés sont liés à des contraintes financières, technologiques et de temps. Ces obstacles sont identiques à ceux rapportés dans une revue méthodique réalisée avant 2009 et demeurent d’importants facteurs rendant difficiles la mise en œuvre d’un tel système. Nous avons rencontré ces difficultés pendant le processus d’adoption de DMI spécifiques à la prise en charge de la douleur aiguë dans notre institution. En outre, nos résultats soulignent l’importance de la participation des médecins dans les étapes de mise au point et de mise en œuvre du DMI afin d’intégrer leurs commentaires et de garantir que le système de DMI s’intègre dans leur flux de travail.


L’utilisation du DMI deviendra inévitablement la norme de soins; toutefois, de nombreux obstacles persistent et freinent sa mise en œuvre et son adoption. Ces défis à la mise en œuvre peuvent être résolus en utilisant une stratégie institutionnelle de changement qui tient compte de ces obstacles et fournit les ressources nécessaires à la mise en œuvre. En adoptant le DMI, la communication, la prise en charge des patients, la recherche et la sécurité des patients seront toutes améliorées.



The authors gratefully acknowledge the input from Drs. Michael Szeto, Alan Chaput, and Ilia Charapov, and from Susan Madden (APN) regarding barriers to implementation experienced at The Ottawa Hospital.


Financial support was provided by grants from the Canadian Foundation for Innovation, the Ontario Innovation Trust, Queen’s University and Kingston General Hospital. Financial and/ or in-kind support was also provided by Cissec Corporation, the Claire Nelson Bequest Fund, Bickell Foundation, Health Evidence Application and Linkage Network, Pfizer, Merck, Purdue Pharma, Avaya, SMC Networks, Cisco, Compaq, and Smith Industries.

Conflicts of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Canadian Anesthesiologists' Society 2013

Authors and Affiliations

  • David H. Goldstein
    • 1
  • Rachel Phelan
    • 1
  • Rosemary Wilson
    • 1
    • 2
  • Amanda Ross-White
    • 3
  • Elizabeth G. VanDenKerkhof
    • 1
    • 2
  • John P. Penning
    • 4
  • Melanie Jaeger
    • 1
    • 5
    Email author
  1. 1.Department of Anesthesiology & Perioperative MedicineQueen’s UniversityKingstonCanada
  2. 2.School of NursingQueen’s UniversityKingstonCanada
  3. 3.Bracken Health Sciences LibraryQueen’s UniversityKingstonCanada
  4. 4.Department of AnesthesiologyThe Ottawa HospitalOttawaCanada
  5. 5.Department of Anesthesiology & Perioperative Medicine, Victory 2Kingston General Hospital, Queen’s UniversityKingstonCanada

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