***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Many promising technological innovations in health and social care are characterized by nonadoption or ab and onment by individuals or by failed attempts to scale up locally , spread distantly , or sustain the innovation long term at the organization or system level . Objective Our objective was to produce an evidence -based , theory-informed , and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program . Methods The study had 2 parallel components : ( 1 ) secondary research ( hermeneutic systematic review ) to identify key domains , and ( 2 ) empirical case studies of technology implementation to explore , test , and refine these domains . We studied 6 technology-supported programs — video outpatient consultations , global positioning system tracking for cognitive impairment , pendant alarm services , remote biomarker monitoring for heart failure , care organizing software , and integrated case management via data sharing — using longitudinal ethnography and action research for up to 3 years across more than 20 organizations . Data were collected at micro level ( individual technology users ) , meso level ( organizational processes and systems ) , and macro level ( national policy and wider context ) . Analysis and synthesis was aided by sociotechnically informed theories of individual , organizational , and system change . The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback . Results The literature review identified 28 previous technology implementation frameworks , of which 14 had taken a dynamic systems approach ( including 2 integrative review s of previous work ) . Our empirical data set consisted of over 400 hours of ethnographic observation , 165 semistructured interviews , and 200 documents . The final nonadoption , ab and onment , scale-up , spread , and sustainability ( NASSS ) framework included questions in 7 domains : the condition or illness , the technology , the value proposition , the adopter system ( comprising professional staff , patient , and lay caregivers ) , the organization(s ) , the wider ( institutional and societal ) context , and the interaction and mutual adaptation between all these domains over time . Our empirical case studies raised a variety of challenges across all 7 domains , each classified as simple ( straightforward , predictable , few components ) , complicated ( multiple interacting components or issues ) , or complex ( dynamic , unpredictable , not easily disaggregated into constituent components ) . Programs characterized by complicatedness proved difficult but not impossible to implement . Those characterized by complexity in multiple NASSS domains rarely , if ever , became mainstreamed . The framework showed promise when applied ( both prospect ively and retrospectively ) to other programs . Conclusions Subject to further empirical testing , NASSS could be applied across a range of technological innovations in health and social care . It has several potential uses : ( 1 ) to inform the design of a new technology ; ( 2 ) to identify technological solutions that ( perhaps despite policy or industry enthusiasm ) have a limited chance of achieving large-scale , sustained adoption ; ( 3 ) to plan the implementation , scale-up , or rollout of a technology program ; and ( 4 ) to explain and learn from program failures BACKGROUND Policies promoting widespread adoption of electronic medical records ( EMRs ) are premised on the hope that they can improve the coordination of care . Yet little is known about whether and how physician practice s use current EMRs to facilitate coordination . OBJECTIVES We examine whether and how practice s use commercial EMRs to support coordination tasks and identify work-arounds practice s have created to address new coordination challenges . DESIGN , SETTING Semi-structured telephone interviews in 12 r and omly selected communities . PARTICIPANTS Sixty respondents , including 52 physicians or staff from 26 practice s with commercial ambulatory care EMRs in place for at least 2 years , chief medical officers at four EMR vendors , and four national thought leaders . RESULTS Six major themes emerged : ( 1 ) EMRs facilitate within-office care coordination , chiefly by providing access to data during patient encounters and through electronic messaging ; ( 2 ) EMRs are less able to support coordination between clinicians and setting s , in part due to their design and a lack of st and ardization of key data elements required for information exchange ; ( 3 ) managing information overflow from EMRs is a challenge for clinicians ; ( 4 ) clinicians believe current EMRs can not adequately capture the medical decision-making process and future care plans to support coordination ; ( 5 ) realizing EMRs ’ potential for facilitating coordination requires evolution of practice operational processes ; ( 6 ) current fee-for-service reimbursement encourages EMR use for documentation of billable events ( office visits , procedures ) and not of care coordination ( which is not a billable activity ) . CONCLUSIONS There is a gap between policy-makers ’ expectation of , and clinical practitioners ’ experience with , current electronic medical records ’ ability to support coordination of care . Policymakers could exp and current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination . By reforming payment policy to include care coordination , policymakers could encourage the evolution of EMR technology to include capabilities that support coordination , for example , allowing for inter- practice data exchange and multi-provider clinical decision support Background In spite of succesful adoption of electronic patient records ( EPR ) by Norwegian GPs , what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized . We wanted to study primary care physicians ' use of electronic patient record ( EPR ) systems in terms of use of different EPR functions and the time spent on using the records , as well as the potential effects of EPR systems on the clinician-patient relationship . Methods A combined qualitative and quantitative study that uses data collected from focus groups , observations of primary care encounters and a question naire survey of a r and om sample of general practitioners to describe their use of EPR in primary care . Results The overall availability of individual patient records had improved , but the availability of the information within each EPR was not satisfactory . GPs ' use of EPRs were efficient and comprehensive , but have result ed in transfer of administrative work from secretaries to physicians . We found no indications of disturbance of the clinician-patient relationship by use of computers in this study . Conclusion Although GPs are generally satisfied with their EPRs systems , there are still unmet needs and functionality to be covered . It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians Design : Mailed survey to a stratified r and om sample of all medical practice s in Massachusetts in 2005 , with one physician per practice r and omly selected for survey . Measurements :  EHR adoption rates . Results : The response rate was 71 % ( 1345/1884 ) . Overall , while 45 % of physicians were using an EHR , EHRs were present in only 23 % of practice s. In multivariate analysis , practice size was strongly correlated with EHR adoption ; 52 % of practice s with 7 or more physicians had an EHR , as compared with 14 % of solo practice s ( adjusted odds ratio , 3.66 ; 95 % confidence interval , 2.28–5.87 ) . Hospital-based practice s ( adjusted odds ratio , 2.44 ; 95 % confidence interval , 1.53–3.91 ) and practice s that teach medical students or residents ( adjusted odds ratio , 2.30 ; 95 % confidence interval , 1.60–3.31 ) were more likely to have an EHR  . The most frequently cited barriers to adoption were start-up financial costs ( 84 % ) , ongoing financial costs ( 82 % ) , and loss of productivity ( 81 % ) . Conclusions : While almost half of physicians in Massachusetts are using an EHR , fewer than one in four practice s in Massachusetts have adopted EHRs .  Adoption rates are lower in smaller practice s , those not affiliated with hospitals , and those that do not teach medical students or residents . Interventions to exp and EHR use must address both financial and non-financial barriers , especially among smaller practice s. J Am Med Inform Assoc . 2007;14:110–117 . DOI 10.1197/jamia . M2187 . by gest on Sptem er 5 , 2016 One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record ( EHR ) systems throughout the health care industry . Consequently , this investigation focused on the effects of known antecedents of technology adoption on  physician satisfaction with EHR technology and the continued use of such systems . The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience . A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling . Results indicate that effort expectancy ( ease of use ) has the most substantive effect on physician satisfaction and the continued use of EHR systems . As such , health care managers should be especially sensitive to the user and computer interface of prospect i ve EHR systems to avoid costly and disruptive system selection mistakes Abstract Introduction The current model of medical knowledge production , transfer , and application suffers from serious shortcomings . Learning health systems ( LHS ) have recently emerged as a potential solution — systems in which health information generated from patients is continuously analyzed to improve knowledge that will be transferred to patient care . Method Various approaches of data integration already exist and could be considered for the implementation of a LHS . We discuss what are the possible informatics approaches to address the functional requirements of LHS , in the specific context of primary care , and present the experience and lessons learned from the TRANSFoRm project . Result Implemented in 4 countries around 5 systems , TRANSFoRm is based on a local‐as‐view data mediation approach integrating the structural and terminological models in the same framework . It clearly demonstrated that it has the potential to address the requirements for a LHS in primary care , by dealing with data fragmented across multiple points of service . Also , it has the potential to support the generation of hypotheses from the context of clinical care , retrospective and prospect i ve research , and decision support systems that improve the relevance of medical decisions . Conclusion The LHS approach embodies a shift from an institution‐centered to a patient‐centered perspective in knowledge production and transfer and can address important challenges in the primary care setting 
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Concerns about the accessibility , reliability and EMR utility exerted an adverse influence on PCPs ’ attitudes to adoption .
However many were positive about their potential to improve clinical productivity , patient safety and care quality .
Younger , computer-literate PCPs , based in large/multi-group practice s , were more likely to be positively inclined to  EMR use than older physicians , less-skilled in technology use , based in solo practice s. Adequate training , policies and procedures favourably impacted on PCPs ’ views on  EMR implementation .
Financial factors were common system level influencers shaping EMR adoption , from start-up costs to the re sources required by ongoing use .
Conclusions By using the CA Framework to synthesis e the evidence , we identified a linked series of factors influencing PCPs attitudes to EMR adoption .