Facilitating ambulatory electronic health record system implementation: evidence from a qualitative study.
BACKGROUND
Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices.


METHODS
Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods.


RESULTS
Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during "go-live" and, subsequently, when users had more experience with the system.


CONCLUSIONS
Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.
Department of Family Medicine, College of Medicine, The Ohio State University, 273 Northwood and High Building, 2231 North High Street, Columbus, OH 43201, USA ; Division of Health Services Management and Policy, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, USA.
Ann Scheck
AS
McAlearney
Cynthia
C
Sieck
Jennifer
J
Hefner
Julie
J
Robbins
Timothy R
TR
Huerta
D000553:Ambulatory Care / Q000379:methods*; D057286:Electronic Health Records / Q000191:economics / Q000592:standards; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014481:United States