Table 6.

Main themes and corresponding recommendations for EMR users and vendors

Main theme	Recommendations for users	Recommendations for vendors
On-site support was important in all participating sites; Its form and degree of formality varied depending on contextual factors (e.g., practice size, geographic distribution, and affiliation with a hospital). Users often sought support from the vendor for items that were not covered by the service agreement (hardware, network, ancillary devices and other software).	If your clinic is not affiliated with a hospital, consider hiring a local person to support the IT infrastructure (hardware, network, and ancillary devices), at least on an on-call basis.	Recommend users to hire local IT people where applicable, or consider expanding your service package to cover infrastructure-related issues.
	Appoint super-users to provide functional (“how to”) support locally and liaise with the various service providers. Consider the training, responsibilities, and time allocation requirements for these super-users.	Endorse the appointment of super-users and provide them with more extensive training.
All cases recognized the importance of data quality and developed practices to ensure data are entered and documented in a consistent manner.	Ensure data are entered accurately and consistently by all users: appoint a person to develop and share templates and forms; agree on data entry conventions or adopt a standard terminology; undertake data quality assurance actions.	Provide means for ensuring data consistency (e.g., built-in templates and forms), and emphasize the importance of consistency through training and documentation.
There were gaps in users and support personnel’s understanding of each other’s work, and between users’ need for immediate assistance and reality.	Adapt the user manual and training materials to your local context and workflows.	Support contextualization of user manuals and tutorials by providing workflow information, allowing modular design, or participatory documentation (similar to participatory system design).
	Familiarize yourself with basic IT concepts; distinguish critical issues that need to be resolved now (e.g., the system is not available) from less critical problems; understand that some problems may be hard to solve, or require changes to the software, and therefore may take time to fix.	Hire support and training personnel with good interpersonal communication skills who understand the users’ workflow. Make sure they understand users’ need for timely support.