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

This is a review for McAlearney, A. S., Hefner, J. L., Sieck, C. J. and Huerta, T. R. (2015), The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50: 462–488. doi: 10.1111/1475-6773.12227.

Introduction

McAlearney et al. contends that going from paper records to an EHR cannot be equated with complete integration of an EHR into the care process. Both organizational and physician barriers have typically been blamed for slow uptake of EHR systems into workflows. They also state, eight main categories of physician barriers were identified by a 2010 review of 22 research articles on barriers to EHR acceptance: financial, technical, time, psychological, social, legal, organizational, and change process. These physician barriers align to barriers identified at the organization level, and both types are well-understood by practitioners and researchers. Some view these barriers as the focal point of interventions—removing them will accelerate EHR adoption. An alternative framing, however, is of EHR adoption as a change process that is slowed due to participant resistance, according to McAlearney et al.

Objective

In the article, McAlearney et al. proposed that EHR adoption is contingent not just on removing barriers but on addressing the change processes involved—at both the individual and organizational levels. The researchers set out to examine administrators' and physicians' perspectives about how adoption and implementation of an EHR system can be facilitated. research objective, shared with study participants, was to improve our collective understanding of EHR implementation strategies to advance the adoption and implementation of ambulatory EHRs, paying particular attention to opportunities to maximize physician adoption and use of such systems. The five stages of Kübler-Ross's model—denial, anger, bargaining, depression, and acceptance—can be articulated as required phases of personal change for physicians adopting and integrating an EHR system.