Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study
Authors: Garcia Gracie , Crenner Christopher 
Published: October 2021

Background
The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway.

Objective
This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed.

Methods
We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results.

Results
Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues.

Conclusions
Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research.