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.

Data sources/study setting: 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.

Study design: We conducted interviews and focus groups in an extensive qualitative study.

Data collection/extraction methods: Verbatim transcripts were analyzed both deductively and inductively using the constant comparative method.

Principal findings: 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.

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.