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VOLUME 50 | NUMBER 2 | APRIL 2015


The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation

Keywords: Electronic health records;medical informatics;information systems;information management/systems/computerization ambulatory/physician office health information technology;EHR/EMR implementation;organizational change;change management;stages of grief

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.

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