Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory

Abstract

BackgroundGlobal evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and, in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK.MethodsQualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings.ResultsHealth professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care.ConclusionsHealth professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.

Integrating Option Grid Patient Decision Aids in the Epic Electronic Health Record: Case Study at 5 Health Systems

“…In our case, the clinical champion served as an intermediary between the study team and the Epic software analysts, facilitated prioritization, and identified the EHR menu button location to ensure visibility. Clinicians' input in the integration process is reported to potentially cause the sustained use of the tools in practice [41,42] and is key to an integration effort, regardless of the format or mode of delivery [14,[43][44][45].…”

Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation—a before-and-after study

“…Thus, healthcare workers generally endorse the idea of an EHR, which raises the question whether EHR implementation should actually be associated with an increase in autonomous motivation. However, as EHR systems were originally developed to support billing, administration, and regulation of healthcare [ 64 ], healthcare workers often experience practical struggles with the system and frustrations about usability issues and a lack of compatibility between the EHRs and their clinical work [ 19 , 30 , 45 ]. Because the quality of their clinical work is so important for healthcare workers, the struggles and frustrations that follow from working with these systems in clinical practice might negatively affect their intrinsic motivation, and might counteract the positive consequences of EHR implementation on autonomous motivation through an increased sense of identified regulation.…”

“…In the following paragraphs, we will argue that two specific work characteristics are particularly relevant in case of EHR implementation, and are especially likely to affect satisfaction of the basic psychological needs for autonomy and relatedness: job autonomy and interdependence . Note that, in this study, we do not consider the need for competence [ 8 ], as we anticipate that feelings of competence are more likely to be affected by the quality of training, IT skills and ‘teething troubles’ of the system [ 7 , 19 , 30 ], which are not the main focus of this study.…”

Is this an epic innovation? Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation – a before-and-after study

“…Thus, healthcare workers generally endorse the idea of an EHR, which raises the question whether EHR implementation should be associated with an increase in autonomous motivation. However, as EHR systems were originally developed to support billing, administration and regulation of healthcare [59], healthcare workers often experience struggles with the system and frustrations about usability issues and a lack of compatibility between the EHRs and their clinical work [19,29,44]. The struggles and frustrations that follow from working with these systems in clinical practice might negatively affect healthcare workers' intrinsic motivation, and might counteract the positive consequences of EHR implementation on autonomous motivation through an increased sense of identi ed regulation.…”

“…Subsequently, we will argue that two work characteristics are particularly relevant in case of EHR implementation, namely; job autonomy and interdependence, which are likely to affect satisfaction of the basic psychological needs for autonomy and relatedness. We do not consider the need for competence [8], as we anticipate that feelings of competence are particularly likely to be affected by the quality of training, IT skills and teething troubles of the system [7,19,29], which are not the main focus of this study. Job autonomy.…”