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The journey through grief: insights from a qualitative study of electronic health record implementation.

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.