Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland.
OBJECTIVE
To explore the impact of implementing an electronic health record system on staff at a Scottish hospice.


BACKGROUND
Electronic health records are broadly considered preferable to paper-based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice.


METHODS
Naturalistic prospective repeated-measures mixed-methods approach.


METHODS
Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free-text comments and focus group. Participants were all 150 employees of a single hospice in Scotland.


RESULTS
Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change.


CONCLUSIONS
It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the 'J-curve' theory of organisational change, and as such, it is both predictable and manageable for other organisations.


CONCLUSIONS
It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity ('J' curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.
School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.
Austyn
A
Snowden
Ayrshire Hospice, Ayr, UK.
Hildegard
H
Kolb
D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D017051:Hospice Care / Q000458:organization & administration*; D006738:Hospices; D006801:Humans; D016247:Information Storage and Retrieval / Q000592:standards*; D009936:Organizational Innovation; D011446:Prospective Studies; D012606:Scotland
caring; computerised; health services research; implementation; nursing information systems; nursing workforce; organisational behaviour; palliative care; technology