Electronic medical record compliance and continuity in delivery of care: an empirical investigation in a combat environment

Electronic medical records (EMRs) are central to continuity in delivery of care in a combat environment. Yet, despite their benefits, technological advances, and legislation mandating their use, EMRs are not widely diffused in the U.S. military. Several contextual factors, such as armed conflict, multiple layers of bureaucracy, inconsistent rotation schedules, and competing goals, contribute to the complexity and difficulty of EMR implementation in a combat environment. This study applies a principal–agent perspective to understand barriers to EMR policy compliance in the U.S. military. Using a unique data set collected over a 105‐week period, we investigate the implementation and effect of monitoring and sanctions on EMR compliance in combat support hospitals. Our results show that monitoring and sanctions positively impact the rate of EMR completion, yet they have no effect on the rate of EMRs started. Our results have implications for research and policy on EMR compliance and implementation in vertically integrated healthcare systems.