Epub 2016 Jun 30. Samuelson W, Zeckhauser R. Status quo bias in decision making. To measure the content validity of the revised measurement items, a group of experts with experience in the field of health informatics was formed, consisting of five professors of nursing colleges and two doctoral students working at the hospitals. Electronic health record adoption among obstetrician/gynecologists in the United States: physician practices and satisfaction. PubMed Central WEB FIRST. 2016. Methods: The theory of planned behavior (TPB) postulates that social norms affect individuals beliefs and behavior [24]; thus, social norms could reinforce or diminish individuals status quo bias [13]. Considering both initial and ongoing costs are ongoing barriers that may disproportionately affect certain organizations that are lagging such as practices in small and rural settings, incentives should be more directly aimed towards correcting these disparities. volume21, Articlenumber:218 (2021) FOIA Pavlou PA, Liang H, Xue Y. Revista de Contabilidad. HHS Vulnerability Disclosure, Help Total variance explained by a single factor was shown to be 42.4%, which was less than the 50% cut-off point [37]. By using this website, you agree to our While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Therefore, no common method bias existed in this study. Electronic Health Record (EHR) Organizational Change: Explaining Though the most crucial factors are being identified by frequency and may not be addressed in the order of significance, this research can potentially be used by policymakers and/or future researchers. 2022 May 3;22(1):120. doi: 10.1186/s12911-022-01858-x. Electronic health records. Epub 2012 Sep 7. the contents by NLM or the National Institutes of Health. PubMed This work is supported by the 2019 Faculty-Student Research Fund granted by the College of Nursing of Yonsei University. A shared spreadsheet was posted to a shared collaboration site, and each reviewer independently made an assessment (1=include, 0=exclude) to determine if the article was germane to our review objective. Self-efficacy for change has a positive effect on perceived ease of use. Archetype-based data warehouse environment to enable the reuse of electronic health record data. Disclaimer. Electronic health records system implementation in Ghana: Health leaders' perspective. Kirkley and Stein [12] indicated that resistance among nurses also plays a key part in the implementation of new nursing information systems. This person will oversee the entire process . Successfully implementing a national electronic health record: a rapid Kim H-W, Kankanhalli A. The implementation of hospital-wide EHR systems is a complex matter involving a range of organizational and technical factors including human skills, organizational structure, culture, technical infrastructure, financial resources, and coordination [ 8, 9 ]. Difficult implementation timelines and time consuming were merged with insufficient time. As a result, further research into the barriers and facilitators of adoption will benefit fewer people as time passes, and thus decrease in overall value. 2012 Jun;36(3):1979-88. doi: 10.1007/s10916-011-9657-6. To implement the EHR successfully, it is crucial to reduce nurses resistance to use the system. However, the fourth study did not examine the relationship between the three factors [14]. Trending health information technology adoption among New York nursing homes. For more information on how to overcome resistance within your organization during EHR implementation, see the following resources. Attafuah PYA, Abor PA, Abuosi AA, Nketiah-Amponsah E, Tenza IS. Data were collected between May and July 2020. Four previous studies have included all three factorsperceived usefulness, perceived ease of use, and resistance to changein their research model to explain intention to use [7, 29, 30] and user resistance behavior [14]. Therefore, resistance does not focus on a specific information system but on the changes in status quo that are generated by the changes in information systems [7, 16]. This control resulted in a great effort to screen through what we knew would be false positives, but in the end it did yield articles that were not discovered in the established research databases. In addition, the Center for Medicare and Medicaid Services (CMS) has also facilitated the expansion of EHRs by providing incentives for adoption and meaningful use, and even penalties for lack of provider engagement [3]. Implementing EHR systems in healthcare facilities has been met with an alarming rate of failure. Second, our study provides more explanation on the effect of acceptance on user resistance behavior. 8600 Rockville Pike The research model explains user resistance behavior as an outcome variable with both inhibitors and enablers drawn from user resistance and technology acceptance literature. 2007;16(6):72537. Clancy T. Integrating AACN essentials, QSEN KSAs, and TIGER competencies for nursing informatics. 2003;27:42578. Studies suggest that smaller, rural hospitals are less likely to adopt as well as practices headed by physicians over the age of 55 [3, 5, 6]. The https:// ensures that you are connecting to the PubMed Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. 2022 Oct 24;24(10):e39614. Hamid F, Cline TW. We had to take some measure to reduce the number of results to something feasible to analyze. doi: 10.1016/j.ijmedinf.2017.02.009. Hence, this study has limitation to reveal causality on user resistance. Of the 34 items, 32 had an item-content validity index (I-CVI) of 0.8 or higher, and the remaining 2 items (Items 5 and 34) had an I-CVI of 0.71 and 0.57, respectively. Int J Healthc Technol Manag. Grinspan ZM, Banerjee S, Kaushal R, et al. As is shown, the date range for the initial search was from 1/1/2011 to 8/3/2016, with the initial date being significant as it represents the beginning of the incentives for Meaningful Use being put into effect. All seven factors were found to be significantly associated with user resistance, either directly or indirectly. Before Article Figures & Data Info & Metrics eLetters PDF Abstract PURPOSE Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. Most of the nurses were working in inpatient units (74.4%), 28 (12.6%) were working in intensive care units, and 13 (5.8%) were working at outpatient units when changing EHR system. 2023 Feb 18;24(1):53. doi: 10.1186/s12875-023-02011-x. To increase perceived ease of use, organizational support could be provided for nurses by making available adequate equipment such as up-to-date workstations as well as appropriate network bandwidth and training for nurses [13]. 2015;18(2):12737. Clipboard, Search History, and several other advanced features are temporarily unavailable. Healthcare staff digital literacy levels and their attitudes towards Sixty-eight nurses (30.5%) showed resistance to change, however only twenty-one (9.4%) showed user resistance behavior. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. This article does not contain any studies with human participants performed by any of the authors. A Four-Step Guide to EHR System Implementation 2007;31:10536. In summary, this study adds empirical finings to theoretical models of user resistance as well as technology acceptance. government site. 1988;1(1):759. sharing sensitive information, make sure youre on a federal Kim YG, Jung K, Park YT, Shin D, Cho SY, Yoon D, Park RW. Inclusion in an NLM database does not imply endorsement of, or agreement with, The authors declare that they have no competing interests. In general, members of the team should be enthusiastic, well-respected and forward thinking. doi: 10.1056/NEJMsa0900592. Electronic Health Record (EHR) Organizational Change - PubMed PMCID: PMC8286589 DOI: 10.1186/s12911-021-01581-z Abstract Background: Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. The implementation of information systems has brought about acceptance as well as resistance [8, 9]. J Med Internet Res. This study explored factors associated with user resistance behavior which were all directly or indirectly associated and provided a preliminary model of user resistance behavior to improve and understand resistance within a theoretical framework. MIS Q. 4 Proven Strategies for a Successful EHR Implementation 2022 Aug 9;13:897790. doi: 10.3389/fpsyg.2022.897790. Psychol Bull. A total of 240 survey questionnaires were distributed (120, 50, 40, and 30 in each hospital), 235 questionnaires (115, 50, 40, and 30 from each hospital) were collected, and 223 questionnaires were completed. Rate of electronic health record adoption in South Korea: a nation-wide survey. See this image and copyright information in PMC. Likely, there will be resistance to this change from the clinical and support staff all the way up to the board members and stakeholders. Some studies regarding user resistance and acceptance have argued that organizations usually limit their measures to improve ease of use in the technical aspects [19, 20]. Google Scholar. Vest JR, Yoon J, Bossak BH. Coping with Complexity: Addressing the 10 Key Challenges of EHR Self-efficacy for change had the third highest total effect on user resistance behavior (0.25), with only indirect effects via resistance to change and perceived ease of use-resistance to change. 2012;36(3):19651977. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2014;43(3):238. The site is secure. Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings. Colleagues opinions (path coefficient=0.25, P=0.043) and self-efficacy (path coefficient=0.20, P=0.037) had a significantly negative impact on resistance to change, while perceived value (path coefficient=0.10, P=0.03) and organizational support (path coefficient=0.08, P=0.291) were not significant. J Med Syst. Thus, resistance to the implementation of a new EHR system would be lower if colleagues perceptions of the new system are favorable. Epub 2022 Mar 1. eCollection 2022. Additionally, the relationship between self-efficacy and perceived ease of use also supports TAM3 [28]. Most evaluations of EHR implementations in the literature apply to large practice settings. From our sample of 27 articles, we identified 68 barriers (that we collapsed into 39) that appeared in the literature a total of 125 times. Kline RB. 2009;18(8):11518. An official website of the United States government. Careers, Unable to load your collection due to an error. Common method biases in behavioral research: a critical review of the literature and recommended remedies. 1 Min Read John Lynn 1 Comment Share This! Similarly, our study shows that perceived usefulness is crucial to reduce user resistance behavior, which is consistent with the findings of Laumer et al. Resistance to change was found to be the strongest predictor of user resistance behavior among mediating factors followed by perceived usefulness and perceived ease of use. 2020;26(3):18592. Unauthorized use of these marks is strictly prohibited. Financial incentives [13, 14, 18, 21] and productivity loss [12, 20, 21, 27] appeared 3.2% of all occurrences (4/125). Physician specialty and variations in adoption of electronic health records. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. How can I increase electronic health record stakeholder involvement? Orlando: National Nursing Informatics Deep Dive Program; 2015. Clemens Scott Kruse declares that he has no conflicts of interest. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. We attempted to control for this bias through our many consensus meetings. Barriers to Electronic Health Record System Implementation and Factors associated with nurses' user resistance to change of electronic This is consistent with the findings of Chis study that show the relationship between colleagues opinions and resistance to change negatively [29]. The end . Auditable Events and Tamper-Resistance . Ajzen I. Nurses were observed to manifest less resistance behavior if they recognized the new EHR as useful for their job; after considering its advantages and disadvantages, it was found that the benefits of a new EHR is greater than the effort it requires to use it [3]. Ryu I, Hwang J-H. Role of distance learning self-efficacy in predicting user intention to use and performance of distance learning system. statement and The composite reliability (CR) and the average variance extracted (AVE) for all constructs should exceed 0.7 and 0.5, respectively [34]. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff. The most often cited barrier is cost, technical concerns, implementation, and user perceptions [23, 24, 26]. PMC Both perceived value (path coefficient=0.65, P<0.001) and colleagues opinions (path coefficient=0.27, P<0.001) had a significantly positive impact on perceived usefulness. 2012;36(3):196577. Barriers to Electronic Health Record Adoption: a Systematic Literature 2017;101:1007. Perceived value has a positive effect on perceived usefulness. Moreover, the TAM2 posits that subjective norms have a positive effect on perceived usefulness and that if co-workers suggest that a system might be useful, their colleagues might come to believe this too [27]. sharing sensitive information, make sure youre on a federal Additionally, the status quo bias theory of Samuelson and Zeckhauser posits that individuals are likely to remain in their current situation; thus, user resistance manifests as a preference to continue using the current system or as a refusal to use a new system [13]. Four factors are included as antecedents of user resistance: perceived value (PV), colleagues opinions (CO), self-efficacy for change (SE), and organizational support for change (OS). To our knowledge, only a single study has explored the association between user resistance behavior and resistance to change, perceived usefulness, and perceived ease of use, where all three factors had a direct relationship with user resistance behavior, but the said study did not explore the indirect effect of the aforementioned factors on user resistance behavior [14]. Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011. The Advanced Guide To EHR Implementation - CapMinds Int J Med Inform. 2 Map out the workflows. In other words, we hypothesize that individuals who have higher perceived usefulness or perceived ease of use would have less resistance to change. Acta Inform Med. Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Three databases were used to acquire articles for this review: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed (MEDLINE Complete) and Google Scholar. Article A technology acceptance model for empirically testing new end-user information systems: theory and results. Second, we empirically tested the research model in a hospital setting. Official Website of The Office of the National Coordinator for Health Information Technology (ONC), Health Information Technology Advisory Committee (HITAC), Health IT and Health Information Exchange Basics. With an exceedingly high volume of patient data, extracting, moving and repopulating is a tedious and time-consuming process. In this model, perceived usefulness is deemed high when individuals recognize that new information systems can be useful in terms of job relevance, output quality, and result demonstrabilitythat is, if individuals believe that a new EHR system is valuable to their work, they would perceive it as useful. Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. 1991;50(2):179211. Electronic health record (EHR) systems often face user resistance in hospitals, which results in a failure to acquire their full benefits. Results: If individuals feel that new information systems enhance their job performance or require no effort to use, they tend to accept rather than reject the systems. Complexity of system and limitations of system were grouped together. sharing sensitive information, make sure youre on a federal These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff. Devlin, A.M., McGee-Lennon, M., ODonnell, C.A., Bouamrane, M.M., Agbakoba, R., OConnor, S., Grieve, E., Finch, T., Wyke, S., Watson, N., and Browne, S., Delivering digital health and well-being at scale: lessons learned during the implementation of the Dallas program in the United Kingdom. Hospitals could employ nurses with higher self-efficacy as champions to form favorable opinions among colleagues. 2004;6(1):3255. PubMed -. 2004;23(4):18490. Most prior studies regarding the successful implementation of the EHR have focused on user acceptance after the Technology Acceptance Model (TAM) was introduced by Davis [17], and only a few have focused on user resistance, especially quantitative empirical studies [3, 7, 8, 13, 18]. Kaltenbrunner KA, Sttzer S, Grb B, Martin S. Front Psychol. Google Scholar. The HITECH act began with the carrot of incentives to adopt HIT, but now it only offers the stick of reduced reimbursements for those who do not adopt HIT. doi: 10.1016/j.pmrj.2017.02.007. Beau Jones declares that he has no conflicts of interest. 2003;42(4):4716. 2013 Oct;82(10):940-53. doi: 10.1016/j.ijmedinf.2013.05.010. 2019;27(5):30510. Before 2003;10(4):257. How to overcome the challenges of EHR implementation - EHR in Practice Workflow Disruption. Fig.1,1, after the filters were enabled the number of results was reduced to 154 possible articles. Our finding shows that nurses tend to have more perceived usefulness and less resistance to change if their colleagues show favorable opinions toward new information systems, because they have similar working conditions. Introduction Capturing and effectively using clinical information and knowledge to ensure a quality, safe and sustainable healthcare service is widely recognised as important [ 1, 2] and data from electronic health records (EHRs) have been vital to decision-making on public health policies during the COVID-19 pandemic [ 3 ].
