Barriers in Electronic Health Records Implementation

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Kruse et al. (2016) claimed that the use of EHR “has increased substantially through efforts to achieve the following: reduce medical errors, provide more effective methods of communicating and sharing information among clinicians” (p. 1). However, despite all associated benefits, the worldwide implementation of nationwide EHRs has progressed much more slowly than anticipated (Morrison et al., 2011, as cited in Fragidis & Chatzoglou, 2018). This paper explores existing barriers to EHR implementation and seeks to provide possible solutions for overcoming them. Specific attention will be given to the measures of positive stimulation within the behavioral theory since physicians’ behavior may stay persistent even if financial and organizational issues are resolved successfully.

Afrizal, S. H., Hidayanto, A. N., Handayani, P. W., Budiharsana, M., & Eryando, T. (2019). Narrative review for exploring barriers to readiness of electronic health record implementation in primary health care. Healthcare Informatics Research, 25(3), 141-152.

Afrizal et al. (2019) studied the barriers and enabling factors to EHR readiness in primary care settings between developed and developing countries. A systematic review of relevant sources allowed to grasp the key difference in EHR implementation. While the physicians in the developed countries were mainly hindered by unfamiliarity with new applications, their counterparts from the developing countries had a general lack of computer literacy (Afrizal et al., 2019). Therefore, the barriers in the developing countries are attributed to behavioral and management rather than technical factors. In the light of this insight, Afrizal et al. (2019) suggest to “enhance the skill of the medical staff in using computers” in developing countries (p. 149).

Beglaryan, M., Petrosyan, V., & Bunker, E. (2017). Development of a tripolar model of technology acceptance: Hospital-based physicians’ perspective on EHR. International Journal of Medical Informatics, 102, 50-61.

This study presents a case of a nationwide EHR implementation effort in Armenia, a post-Soviet developing country. 233 physicians across 20 Armenian hospitals participated in quantitative questionnaire-based research, which revealed direct determinants for EHR acceptance. These determinants are group-level clinical concerns, impact on performance, required effort from physicians, interference with patient-provider relationships, and resistance to change (Beglaryan et al., 2017, p. 56). Beglaryan et al. (2017) proposed an amended tripolar model of technology acceptance (TMTA) as a means of predicting and explaining possible barriers to healthcare technology acceptance. Unlike the previously used Technology Acceptance Model (TAM), TMTA considers social and organizational aspects of decision making (Beglaryan et al., 2017). Overall, TMTA links together key elements of healthcare — practitioners, patients, and provider organizations.

Dasari, M., Garbett, M., Miller, E., Machaín, G. M., & Puyana, J. C. (2016). Implementation of a hospital electronic surgical registry in a lower-middle-income country. World Journal of Surgery, 40(12), 2840-2846.

Dasari et al. (2016) evaluated the implementation of a tablet-based mobile EHR tool in a surgical registry of a large urban hospital in Asuncion, Paraguay. The qualitative research based on conducting focus groups with hospital personnel revealed reinforcement of the tool’s use and the staff responsibilities as the most important domains influencing implementation (Dasari et al., 2016). Additionally, the study results “do corroborate some of the findings” regarding physician unwillingness to transition in lower-middle-income countries (Dasari et al., 2016, p. 2844). Overall, the methodology of pre-implementation focus groups proved to be capable of uncovering the barriers within a particular healthcare organization.

Fragidis, L. L., & Chatzoglou, P. D. (2018). Implementation of a nationwide electronic health record (EHR): The international experience in 13 countries. International Journal of Health Care Quality Assurance, 31(2), 116-130.

This article explores the strategies of nationwide-scale EHR implementation, highlights possible barriers, and provides a solid reference point for further research of the subject. In particular, the experts from 8 out of 13 countries featured in the study identified users’ acceptance as the most significant barrier in EHR implementation (Fragidis & Chatzoglou, 2018). One of the notable takeaways from the study — “a way of overcoming EHR implementation difficulties, should also be directed at doctors and not only to patients” (Fragidis & Chatzoglou, 2018, p.126). Overall, the study underscores the necessity of all stakeholders’ involvement in the process in order to achieve success.

Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to electronic health record adoption: A systematic literature review. Journal of Medical Systems, 40(12), 1-7.

Kruse et al. (2016) have composed a comprehensive literature review, which provides a complex exploration of the barriers emerging during the EHR adoption in the U.S. healthcare organizations. This information is valuable for understanding the nature of fundamental issues, which may hinder the EHR implementation. In total, the analysis revealed 39 barriers mentioned in the literature 125 times (Kruse et al., 2016). The initial cost of implementation was the most pressing concern, appearing in 14,4% of occurrences; however, resistance to changing work practices was also a significant problem mentioned in 6,4% of cases (Kruse et al., 2016). As such, Kruse et al. (2016) suggested policymakers supplement financial incentives with measures aimed at improving EHRs appeal to older physicians.

Mason, P., Mayer, R., Chien, W. W., & Monestime, J. P. (2017). Overcoming barriers to implementing electronic health records in rural primary care clinics. The Qualitative Report, 22(11), 2943-2955.

Mason et al. (2017) studied the issues arising during the EHR implementation in a rural primary care setting. Qualitative interview-based research conducted among the physicians and physician assistants across two rural primary care clinics in Missouri led to discovering four emergent themes (Mason et al., 2017). The participants were concerned with a “lack of finances to support EHRs, health information exchange issues, lack of business education, and lack of change management in rural medical practices” (Mason et al., 2017, p. 2950). Following these findings, the article formulates several practical suggestions for rural primary care providers and general business leaders on how to address the revealed problems.

McAlearney, A. S., Hefner, J. L., Sieck, C. J., & Huerta, T. R. (2015). The journey through grief: Insights from a qualitative study of electronic health record implementation. Health Services Research, 50(2), 462-488.

This paper applies the “five stages of grief” framework initially developed by Elizabeth Kübler-Ross to the EHR implementation process in six health systems across the United States. In addition to explaining and evaluating the physician’s grief via the qualitative interview-based approach, McAlearney et al. (2015) provide ten EHR deployment strategies for healthcare organization management. These strategies are tied to respective grief stages and can be used by the managers to “mitigate EHR implementation problems and potentially move employees to the next stage of change” (McAlearney et al., 2015). As such, the paper presents a valid instrument for overcoming behavioral barriers in the EHR implementation.

Threatt, T., Pirtle, C. J., Dzwonkowski, J., & Johnson, K. B. (2020). Using a custom mobile application for change management in an electronic health record implementation. JAMIA Open, 3(1), 37-43.

Threatt et al. (2020) provide an experience of unified mobile and web-based platform use during the EHR replacement at Vanderbilt University Medical Center (VUMC). An application called “Hubbl” was designed to coordinate pre-go live work, go-live work, and post-go live work among the EHR users (Threatt et al., 2020). The use of mobile application significantly facilitated users’ involvement in changes associated with commercial EHR adoption. For instance, Hubbl provided an ability “to receive rapid and ongoing daily feedback from frontline users at each site” (Threatt et al., 2020). In this regard, the article confirms the feasibility of mobile applications for improving physicians’ experience during the EHR implementation or replacement.

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: a scoping review and qualitative analysis of the content. Life, 10(12), 327.

A review by Tsai et al. (2020) supplements and updates the information regarding the existing barriers in EHR implementation. In total, the authors reviewed 7641 studies, of which 142 met all eligibility criteria. Among the most frequently occurring barriers were “resource constraints, poor/insufficient training, and a lack of technical/educational support for users” (Tsai et al., 2020, p. 17). The article also identifies both positive and negative effects of EHR implementation in regard to data and information handling, clinical work, and economic impact on healthcare organizations. In addition, the review highlights the consistency of negative effects and barriers to EHR implementation over time, which means that they can be identified and addressed reliably.

Wilkinson, S., Borycki, E., & Kushniruk, A. (2020). Best practices for EHR implementation: A BC First Nations community’s experience. Healthcare Management Forum, 33(1), 39-46.

Wilkinson et al. (2020) examined a case of successful EHR implementation at the First Nations health center in British Columbia, Canada, with a goal to identify practices most beneficial for the process. The interviews with First Nation’s staff members verified the use of such practices as early planning, leadership, stakeholder involvement, and benefit selling to the staff (Wilkinson et al., 2020, p. 41). In addition, “the resolution of privacy and confidentiality issues” was defined as a critical condition for success in EHR adoption (Wilkinson et al., 2020, p. 45).

References

Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to electronic health record adoption: A systematic literature review. Journal of Medical Systems, 40(12), 1-7.

Mason, P., Mayer, R., Chien, W. W., & Monestime, J. P. (2017). Overcoming barriers to implementing electronic health records in rural primary care clinics. The Qualitative Report, 22(11), 2943-2955. Web.

McAlearney, A. S., Hefner, J. L., Sieck, C. J., & Huerta, T. R. (2015). The journey through grief: Insights from a qualitative study of electronic health record implementation.Health Services Research, 50(2), 462-488.

Threatt, T., Pirtle, C. J., Dzwonkowski, J., & Johnson, K. B. (2020). Using a custom mobile application for change management in an electronic health record implementation. JAMIA Open, 3(1), 37-43.

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life, 10(12), 327.

Wilkinson, S., Borycki, E., & Kushniruk, A. (2020). Best practices for EHR implementation: A BC First Nations community’s experience. Healthcare Management Forum, 33(1), 39-46.

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Barriers in Electronic Health Records Implementation

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