Skip to main content
Log in

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

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Abbreviations

EHR:

electronic health records

IT:

information technology

HIT:

health information technology

References

  1. Cedars-Sinai Suspends CPOE Use. Available at: http://www.ihealthbeat.org/articles/2003/1/22/CedarsSinai-suspends-CPOE-use.aspx?archive=1#. Accessed January 22, 2007.

  2. Han YY, Carcillo JA, Venkataraman ST, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506–12.

    Article  PubMed  Google Scholar 

  3. The White House: President W. Bush. Transforming Health Care: The President’s Health Information Technology Plan. Available at: http://www.whitehouse.gov/infocus/technology. Accessed January 22, 2007.

  4. Jha AK, Ferris TG, Donelan K, et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff (Millwood). 2006;25:w496–507.

    Article  Google Scholar 

  5. Ford EW, Menachemi N, Phillips MT. Predicting the adoption of electronic health records by physicians: when will health care be paperless? J Am Med Inform Assoc. 2006;13:106–12.

    Article  PubMed  Google Scholar 

  6. Hersh W. Health care information technology: progress and barriers. Jama. 2004;292:2273–4.

    Article  PubMed  CAS  Google Scholar 

  7. Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff (Millwood). 2004;23:184–90.

    Article  Google Scholar 

  8. Gans D, Kralewski J, Hammons T, Dowd B. Medical groups’ adoption of electronic health records and information systems. Practices are encountering greater-than-expected barriers to adopting an EHR system, but the adoption rate continues to rise. Health Aff (Millwood). 2005;24:1323–33.

    Article  Google Scholar 

  9. O’Connell RT, Cho C, Shah N, Brown K, Shiffman RN. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc. 2004;11:43–9.

    Article  PubMed  Google Scholar 

  10. Smith D, Newell LM. A physician’s perspective: deploying the EMR. J Healthc Inf Manag. 2002;16:71–9.

    PubMed  Google Scholar 

  11. Ventres W, Kooienga S, Vuckovic N, Marlin R, Nygren P, Stewart V. Physicians, patients, and the electronic health record: an ethnographic analysis. Ann Fam Med. 2006;4:124–31.

    Article  PubMed  Google Scholar 

  12. Zaroukian MH, Sierra A. Benefiting from ambulatory EHR implementation: solidarity, six sigma, and willingness to strive. J Healthc Inf Manag. 2006;20:53–60.

    PubMed  Google Scholar 

  13. Key Capabilities of an Electronic Health Record System: Letter Report. Available at: http://www.nap.edu/catalog/10781.html. Accessed January 22, 2007.

  14. Strauss A, Corbin J. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage; 1998.

    Google Scholar 

  15. Sidorov J. It ain’t necessarily so: the electronic health record and the unlikely prospect of reducing health care costs. Health Aff (Millwood). 2006;25:1079–85.

    Article  Google Scholar 

  16. Ash JS, Bates DW. Factors and forces affecting EHR system adoption: report of a 2004 ACMI discussion. J Am Med Inform Assoc. 2005;12:8–12.

    Article  PubMed  Google Scholar 

  17. Scott JT, Rundall TG, Vogt TM, Hsu J. Kaiser Permanente’s experience of implementing an electronic medical record: a qualitative study. Br Med J. 2005;331:1313–6.

    Article  Google Scholar 

  18. Kohn L, Corrigan J, Donaldson M. To Err is Human: Building a Safer Health System. Washington DC: Institute of Medicine (IOM), National Academy of Sciences; 1999.

    Google Scholar 

  19. Bates DW. Commentary: quality, costs, privacy and electronic medical data. J Law Med Ethics. 1997;25:111–2, 82.

    Article  PubMed  CAS  Google Scholar 

  20. Committee on Maintaining Privacy and Security in Health Care Applications of the National Information InfrastructureMathematics, and Applications Commission on Physical SciencesNational Research Council. For the Record: Protecting Electronic Health Information. Washington, DC: National Academy; 1997.

    Google Scholar 

  21. Financial, Legal and Organizational Approached to Achieving Electronic Connectivity in Healthcare: Working Group on Financial, Organizational, and Legal Sustainability of Health Information Exchange. Markle Foundation. October; 2004.

  22. Bright B. Most Americans are unwilling to pay for e-mail with doctors. Wall Street Journal, 1 March 2005.

  23. Health Information Technology Initiative: Major Accomplishments. Available at: http://www.hhs.gov/healthit/privacy. Accessed January 22, 2007.

  24. Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. Jama. 1998;280:1311–6.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by grants from the United Hospital Fund and the NewYork-Presbyterian Hospital. We would particularly like to thank Dr. Mary Cooper at the New York-Presbyterian Hospital for her support of this project. This study was presented at the Pediatric Academic Societies’ 2007 annual meeting held in Toronto, Canada.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stephanie O. Zandieh MD, MS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zandieh, S.O., Yoon-Flannery, K., Kuperman, G.J. et al. Challenges to EHR Implementation in Electronic- Versus Paper-based Office Practices. J GEN INTERN MED 23, 755–761 (2008). https://doi.org/10.1007/s11606-008-0573-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0573-5

KEY WORDS

Navigation