Journal of General Internal Medicine

, Volume 23, Issue 6, pp 755–761

Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices

Authors

    • Department of PediatricsWeill Cornell Medical College
  • Kahyun Yoon-Flannery
    • Department of Public HealthWeill Cornell Medical College
  • Gilad J. Kuperman
    • Department of Public HealthWeill Cornell Medical College
    • Department of Quality AssuranceNewYork-Presbyterian Hospital
    • Department of Biomedical InformaticsColumbia University
  • Daniel J. Langsam
    • Department of PediatricsWeill Cornell Medical College
  • Daniel Hyman
    • Department of Public HealthWeill Cornell Medical College
    • Ambulatory Care NetworkNewYork-Presbyterian Hospital
    • Komansky Center for Children’s HealthNewYork-Presbyterian Hospital
  • Rainu Kaushal
    • Department of PediatricsWeill Cornell Medical College
    • Department of Public HealthWeill Cornell Medical College
    • Division of General Internal MedicineBrigham and Women’s Hospital
Original Article

DOI: 10.1007/s11606-008-0573-5

Cite this article as:
Zandieh, S.O., Yoon-Flannery, K., Kuperman, G.J. et al. J GEN INTERN MED (2008) 23: 755. doi:10.1007/s11606-008-0573-5

Summary

Background

Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems.

Objective

To determine how ambulatory leaders differentiate implementation approaches between practices that are currently paper-based and those with a legacy EHR system (EHR-based).

Design

Qualitative study.

Participants

Eleven practice managers and 12 medical directors all part of an academic ambulatory care network of a large teaching hospital in New York City in January to May of 2006.

Approach

Qualitative approach comparing and contrasting perceived benefits and challenges in implementing an ambulatory EHR between practice leaders from paper- and EHR-based practices. Content analysis was performed using grounded theory and ATLAS.ti 5.0.

Results

We found that paper-based leaders prioritized the following: sufficient workstations and printers, a physician information technology (IT) champion at the practice, workflow education to ensure a successful transition to a paperless medical practice, and a high existing comfort level of practitioners and support staff with IT. In contrast, EHR-based leaders prioritized: improved technical training and ongoing technical support, sufficient protection of patient privacy, and open recognition of physician resistance, especially for those who were loyal to a legacy EHR. Unlike paper-based practices, EHR-based leadership believed that comfort level with IT and adjustments to workflow changes would not be difficult challenges to overcome.

Conclusions

Leadership at paper- and EHR-based practices in 1 academic network has different priorities for implementing a new EHR. Ambulatory practices upgrading their legacy EHR have unique challenges.

KEY WORDS

electronic health records (EHR)implementationschallengesambulatory

Abbreviations

EHR

electronic health records

IT

information technology

HIT

health information technology

Copyright information

© Society of General Internal Medicine 2008