Abstract
BackgroundDespite the potential for electronic health records (EHRs) to improve patient safety and quality of care, the intended benefits of EHRs are not always realized because of implementation-related challenges. Enlisting clinician super users to provide frontline support to employees has been recommended to foster EHR implementation success. In some instances, their enlistment has been associated with implementation success; in other cases, it has not. Little is known about why some super users are more effective than others. The purpose of this study was to identify super users’ mechanisms of influence and examine their effects on EHR implementation outcomes.MethodsWe conducted a longitudinal (October 2012 – June 2013), comparative case study of super users’ behaviors on two medical units of a large, academic hospital implementing a new EHR system. We assessed super users’ behaviors by observing 29 clinicians and conducting 24 in-depth interviews. The implementation outcome, clinicians’ information systems (IS) proficiency, was assessed using longitudinal survey data collected from 43 clinicians before and after the EHR start-date. We used multivariable linear regression to estimate the relationship between clinicians’ IS proficiency and the clinical unit in which they worked.ResultsSuper users on both units employed behaviors that supported and hindered implementation. Four super user behaviors differed between the two units: proactivity, depth of explanation, framing, and information-sharing. The unit in which super users were more proactive, provided more comprehensive explanations for their actions, used positive framing, and shared information more freely experienced significantly greater improvement in clinicians’ IS proficiency (p =0.03). Use of the four behaviors varied as a function of super users’ role engagement, which was influenced by how the two units’ managers selected super users and shaped the implementation climate.ConclusionsSuper users’ behaviors in implementing EHRs vary substantively and can have important influence on implementation success.
Highlights
Despite the potential for electronic health records (EHRs) to improve patient safety and quality of care, the intended benefits of EHRs are not always realized because of implementation-related challenges
EHR implementation context in which super users operated Super users operated within the context of a hospitalwide EHR implementation that had negative and positive aspects
In terms of negative aspects, participants on both units consistently mentioned challenges related to the technology itself, including problems related to the functionality of the EHR and the complexity of the EHR platform
Summary
Despite the potential for electronic health records (EHRs) to improve patient safety and quality of care, the intended benefits of EHRs are not always realized because of implementation-related challenges. Enlisting clinician super users to provide frontline support to employees has been recommended to foster EHR implementation success. In some instances, their enlistment has been associated with implementation success; in other cases, it has not. To foster the successful implementation of EHRs, a common recommendation is to enlist super users [11], or individuals, typically already working within the organization, who receive extra training on the selected EHR system so that they can provide frontline technical support to their peer users [12]. What remains unknown are the mechanisms by which super users influence implementation success at the point of user need and the impact of contextual factors, both of which might explain why super users are effective in some cases but not in others
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