ABSTRACT
This chapter presents respondent perceptions of the electronic medical record implementation process, including the perceived failings and successes, reported levels of Clinical Information System (CIS) use, organisational changes resulting from CIS use, and organisational changes resulting from the implementation experience. Respondents reported several concerns the CIS product design. These concerns included perceived deficiencies in the CIS software, as well as both organisational and technical difficulties in changing the software to fix the identified deficiencies. Within customary practice styles, there appears to have been little slack to absorb the additional time burden of working with CIS. Exposure to CIS had helped to convert a significant mass of Hawaii Kaiser Permanente practitioners to the principle of e-health. Several informants reflected on what Kaiser Permanente had learned from the global experience of trying to implement CIS. Members of the implementation team reported most of the lessons, though one spoke for physicians.
