Physician Interaction with EHR: The Importance of Stakeholder Identification and Change Management

Physician Interaction with EHR: The Importance of Stakeholder Identification and Change Management

Cherie Noteboom (Dakota State University, USA)
DOI: 10.4018/978-1-4666-6339-8.ch058
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Abstract

Research Medical Center is a regional medical center that meets the needs of residents of a rural area in the Midwest. It is part of a large healthcare system. The primary care hospital implemented the Electronic Health Record (EHR). The endeavor to implement Health IT applications including Computerized Physician Order Entry (CPOE), EHRs, nursing documentation, and paperless charts, adverse drug reaction alerts, and more were introduced with the corporate initiative. The core applications were clinical and revenue cycle systems, including CPOE. The planning, implementation, and training was developed by the parent operating company and efforts to engage the local physicians were minimal. There were over 300 physicians involved. The physicians were primarily not hospital employees. They had the ability to choose to adopt the EHR and adapt their social, work, and technology practices, or to avoid usage. Follow up research indicated the change management and support efforts were not successful for the physician stakeholder.
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Setting The Stage

Research has shown that the healthcare industry is plagued by rapidly increasing costs, poor quality of service, lack of integration of patient care, and lack of information access to EHR. According to the Institute of Medicine (IOM, 2001), medical errors are a major problem that decreases the quality and increases the costs of the U.S. healthcare system. Medical errors result in 98,000 deaths a year and many more injuries, and as a result, patient safety has become a top priority in U.S. healthcare.

The use of Information Technology (IT) has the potential to help healthcare organizations improve quality of service while reducing costs. The Institute of Medicine (IOM, 2001) reported that the U.S. healthcare system is “fundamentally broken” and called on the federal government to make a major investment in information technology in order to achieve the changes, such as the “commitment to technology to manage the knowledge bases and process of care” (p. 178), needed to repair the broken healthcare system.

During the past 25 years, many medical records have been converted from a handwritten record format to an EHR format, and studies have indicated that EHR is complicated and requires a serious, sustained commitment to human resources, process re-engineering, technology, and funding. The healthcare system has been slow to take advantage of EHR and realize the benefits of computerization (McDonald, 1997): that is, improved access to and records of patient data, enhanced ability to make better and more-timely decisions, and improved quality and reduced errors.

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