title: Physician experiences transitioning between an older versus newer electronic health record for electronic prescribing.
abstract: OBJECTIVE
  Federal incentives to adopt interoperable, certified electronic health records (EHRs) with electronic prescribing (e-prescribing) are motivating providers using older EHRs to transition to newer EHRs. The objective of this study was to describe, from the perspective of experienced EHR users, the transition from an older, locally developed EHR with minimal clinical decision support (CDS) for e-prescribing to a newer, commercial EHR with more robust CDS for e-prescribing.
  
  
  METHODS
  This qualitative, case study consisted of observations and semi-structured interviews of adult internal medicine faculty members (n=19) at an academic-affiliated ambulatory care clinic from January through November 2009. All providers transitioned from the older, locally developed EHR to the newer, commercial EHR in April 2008. We analyzed field notes of observations and transcripts of semi-structured interviews using qualitative methods guided by a grounded theory approach.
  
  
  RESULTS
  We identified key themes describing physician experiences. Despite intensive effort by the information systems team to ease the transition, even these experienced e-prescribers found transitioning extremely difficult. The commercial EHR was not perceived as improving medication safety, despite having more robust CDS. Additionally, physicians felt the commercial EHR was too complex, reducing their efficiency.
  
  
  CONCLUSIONS
  This is among the first studies examining physician experiences transitioning between an older, locally developed EHR to a newer, commercial EHR with more robust CDS for e-prescribing. Understanding physician experiences with this type of transition and their general preferences for prescribing applications may lead to less disruptive system implementations and better designed EHRs that are more readily accepted by providers. In this way, productivity and safety benefits may be maximized while mitigating potential threats associated with transitions.
  
  
  BACKGROUND
  ClinicalTrials.gov, Identifier: NCT00603070.
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, NY 10065, USA. err9009@med.cornell.edu
authors.forename: Erika L
authors.initials: EL
authors.lastname: Abramson
authors.forename: Vaishali
authors.initials: V
authors.lastname: Patel
authors.forename: Sameer
authors.initials: S
authors.lastname: Malhotra
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Pfoh
authors.forename: S
authors.initials: S
authors.lastname: Nena Osorio
authors.forename: Adam
authors.initials: A
authors.lastname: Cheriff
authors.forename: Curt L
authors.initials: CL
authors.lastname: Cole
authors.forename: Arwen
authors.initials: A
authors.lastname: Bunce
authors.forename: Joan
authors.initials: J
authors.lastname: Ash
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055695:Electronic Prescribing / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research