title: Assessing electronic health record implementation challenges using item response theory.
abstract: OBJECTIVE
  To assess the importance of commonly identified issues in electronic health record (EHR) implementation using item response theory (IRT).
  
  
  METHODS
  Secondary data from the 2012 American Hospital Association's Annual Survey Information Technology Supplement were used in the analyses. Results were compared and contrasted with the standard descriptive statistic frequencies that have been used to guide most recommendations made using the same data.
  
  
  METHODS
  IRT was used to measure the magnitude of difficulty that particular challenges pose in implementing EHRs that meet federal guidelines for Meaningful Use.
  
  
  RESULTS
  The IRT analyses yielded significantly different results from descriptive statistics in estimating the magnitude of specific EHR implementation challenges. In particular, IRT revealed that "obtaining physician cooperation" and "ongoing costs of maintaining and upgrading systems" were the most challenging implementation features. However, the frequency counts identified "upfront capital costs" and "complexity of meeting Meaningful Use criteria within implementation timeline" as the most challenging implementation features.
  
  
  CONCLUSIONS
  For managers and policy makers, having an accurate assessment of EHR implementation challenges is essential to designing effective programs. IRT provides a statistical approach that allows prior studies to be assessed more accurately and future studies to retain the easier-to-use, check-all-that-apply survey structure while gaining valuable information.
authors.forename: Kitty S
authors.initials: KS
authors.lastname: Chan
authors.forename: Hadig
authors.initials: H
authors.lastname: Kharrazi
authors.forename: Megha A
authors.initials: MA
authors.lastname: Parikh
authors.affiliation: 624 N. Broadway, Ste 533, Baltimore, MD 21205. E-mail: ewford@jhu.edu.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Ford
mesh_terms: D000573:American Hospital Association; D004059:Diffusion of Innovation; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D062527:Meaningful Use; D008490:Medical Informatics / Q000458:organization & administration*; D009937:Organizational Objectives; D015397:Program Evaluation; D014481:United States