We report results of a longitudinal case study in which an emergency medical service replaced a paper-based medical record with an electronic medical record system. The new systems electronically transmitted patient information to various other agencies for reporting, medical quality control, and billing purposes. As expected, the time required for the paramedics to document the medical record increased immediately after system implementation. As a result, operational performance of the paramedics declined. An unexpected consequence of system implementation was that operational performance never reached the level achieved prior to system implementation. However, the benefits attained by all organizations involved outweighed the prolonged decrease in operational performance of the paramedics. Therefore, we advise organizations implementing technology crossing organizational boundaries to consider both the direct and indirect benefits of a system implementation and to evaluate both operational and organizational performance.
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