title: The journey through grief: insights from a qualitative study of electronic health record implementation.
abstract: OBJECTIVE
  To improve understanding of facilitators of EHR system implementation, paying particular attention to opportunities to maximize physician adoption and effective deployment.
  
  
  METHODS
  Primary data collected from 47 physician and 35 administrative key informants from six U.S. health care organizations identified because of purported success with EHR implementation.
  
  
  METHODS
  We conducted interviews and focus groups in an extensive qualitative study.
  
  
  METHODS
  Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method.
  
  
  RESULTS
  Conceptualizing EHR adoption as loss through the lens of Kübler-Ross's five stages of grief model may help individuals and organizations more effectively orient to the challenge of change. Coupled with Kotter's eight-step change management framework, we offer a structure to facilitate organizations' movement through the EHR implementation journey. Combining insights from these frameworks, we identify 10 EHR strategies that can help address EHR implementation barriers.
  
  
  CONCLUSIONS
  Loss is one part of change often overlooked. Addressing it directly and compassionately can potentially facilitate the EHR implementation journey. We offer a summarized list of deployment strategies that are sensitive to these issues to support physician transition to new technologies that will bring value to clinical practice.
authors.affiliation: Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH.
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hefner
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Sieck
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Huerta
mesh_terms: D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006117:Grief; D006801:Humans; D007407:Interviews as Topic; D008016:Life Change Events; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D014481:United States
keywords: EHR/EMR implementation; Electronic health records; change management; information management/systems/computerization ambulatory/physician office health information technology; information systems; medical informatics; organizational change; stages of grief