staff resistance to ehr implementation

Additionally, this model includes concepts about an individuals perception that mediate the associated factors and user resistance behavior [7]. Bookshelf Michelle Perregrini PMID: 31085670 DOI: 10.1891/1078-4535.25.2.154 Abstract Resistance to change is a prevalent issue in nursing, with ongoing interventions needed to increase awareness and to support nurses on the journey to becoming change agents. That is, EHR resides in the center of the work of healthcare providers in the hospital; thus, colleagues opinions would be salient in forming the perception of users. The implementation of information systems has brought about acceptance as well as resistance [8, 9]. Trending health information technology adoption among New York nursing homes. Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in US hospitals. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. 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 study examined the factors associated with nurses user resistance behavior after the implementation of a new EHR system. The graphical representation of the path diagram showing the relationship between different variables includes user resistance behavior (dependent), perceived usefulness, perceived ease of use, and resistance to change as endogenous variables, as well as perceived value, colleagues opinion, self-efficacy, and organizational support as exogenous variables. According to Kim and Kankanhalli, organizational support, which is included in the external mean method of the status quos bias control, is defined as the organizations perceived facilitation to allow users to adapt to information system-related changes easily [13]. Of interesting note is that of interoperability. Xierali IM, Phillips RL, Jr, Green LA, et al. Clemens Scott Kruse declares that he has no conflicts of interest. An evaluation of ehr and the barriers to adoption by small medical practices. Asia Pac J Inf Syst. Int Wound J. Third, as this study was conducted in university hospitals, the findings may not be generalized to non-academic hospitals which have less resources, facilities or IT infrastructure. Federal government websites often end in .gov or .mil. To implement the EHR successfully, it is crucial to reduce nurses' resistance to use the system. Conclusions: 1991;50(2):179211. Unauthorized use of these marks is strictly prohibited. For example, cost, lack of capital resources to invest in EHR, financial challenges, cost of purchasing system, initial cost of HIT and lack of financial resources were grouped into initial cost. Second, our study provides more explanation on the effect of acceptance on user resistance behavior. 2009;33:56782. official website and that any information you provide is encrypted [14]. According to the TAM3, individuals with high self-efficacy and those supported by their organization tend to have high perceived ease of use. 2013 Oct;82(10):940-53. doi: 10.1016/j.ijmedinf.2013.05.010. Focusing on small ambulatory . -, Thit WM, Thu SWYM, Kaewkungwal J, Soonthornworasiri N, Theera-Ampornpunt N, Kijsanayotin B, Lawpoolsri S, Naing S, Pan-Ngum W. User acceptance of electronic medical record system: implementation at Marie Stopes International, Myanmar. Cookies policy. All data were analyzed using RStudio software (version 1.3.1056, RStudio, PBC). According to Kim and Kankanhalli [13], self-efficacy is defined as individuals confidence in their ability to adapt to new situations. Epub 2022 Mar 1. More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. Who are the key stakeholders during electronic health record implementation? Kim J, Park K. A study on the relation between personal characteristics and psychological resistance to change & organization commitment. The reviewers agreed to analyze the articles for possible bias, basic findings germane to our objective, and barriers that tie multiple studies together. We had to take some measure to reduce the number of results to something feasible to analyze. Progress and challenges: implementation and use of health information technology among critical-access hospitals. 1. 2020;26(3):185192. This article is part of the Topical Collection on Transactional Processing Systems, National Library of Medicine These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. -. Acceptance of information systems does not imply that there is no user resistance, especially in the case of mandatory systems. HHS Vulnerability Disclosure, Help Path analysis was conducted to examine the direct and indirect effects of other variables on user resistance behavior. Lapointe L, Rivard S. A multilevel model of resistance to information technology implementation. PMC A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. EHR Implementation: Top Challenages and Barriers to Adoptation and Use Health Aff. 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]. Both perceived usefulness and perceived ease of use act as essential cognitive determinants to improve acceptance in the TAM and the Unified Theory of Acceptance and Use of Technology [31]. government site. Policy makers should consider the results of this review when shaping additional policies and incentives for healthcare organizations in the future. 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]. Hence, this study aimed to investigate the factors associated with nurses user resistance behavior to the EHR. Introduction. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Results: Reinforce: Reinforce the value of each team member and provide support to resistors. 2015;33(5):18998. Electronic health records system implementation in Ghana: Health leaders' perspective. Int J Med Inform. Google Scholar. 2022 Sep 22;22(1):249. doi: 10.1186/s12911-022-01998-0. We will discuss our findings with those of previous studies in terms of theory and practice in this discussion section. The research model explains user resistance behavior as an outcome variable with both inhibitors and enablers drawn from user resistance and technology acceptance literature. 2. The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Kim YG, Jung K, Park YT, Shin D, Cho SY, Yoon D, Park RW. Each article was thoroughly examined by multiple authors in order to achieve greater validity. Furthermore, research considering both resistance and acceptance are scarce, even though resistance is not the opposite of acceptance and could occur with acceptance simultaneously. Abramson EL, Edwards A, Silver M, et al. Healthcare informatics research. 2008;39(2):273315. Involve: Involve all staff members in the decision-making process. 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. Hospital leaders should communicate their rationale for implementing a new EHR system, as well as their vision for the project before or at least in the beginning of its implementation [10, 13]. This study was a descriptive correlational study conducted in four university hospitals in South Korea that had implemented a new EHR system in the preceding two years. Moreover, the correlation between perceived usefulness and colleagues opinions as well as perceived value and colleagues opinions were higher than 0.5 (0.53, 0.54, respectively). Taylor H, Brumitt G, Harle CA, Johnston A, Williams K, Vest JR. J Health Adm Educ. BMC Med Inform Decis Mak 21, 218 (2021). 2009;360(16):16281638. 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]. The end . Clancy T. Integrating AACN essentials, QSEN KSAs, and TIGER competencies for nursing informatics. Generally, individuals dislike losing control because of changes in their work routine, as in the case of implementing a new information system, which reinforces status quo bias [23]; this corresponds to perceived behavioral control of the TPB. Data migration: Moving all paper-based documents to digital records is an upheaval task. Hospitals could employ nurses with higher self-efficacy as champions to form favorable opinions among colleagues. Participants characteristics are shown in Table 1. Perceived ease of use had a total effect of0.16, with only indirect effect via resistance to change. Abramson EL, McGinnis S, Moore J, et al. Simpson, J. L. Jr., Examining differences in electronic health record adoption and motivations between small and large physician practices. Federal government websites often end in .gov or .mil. Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011. Date 9/30/2023, U.S. Department of Health and Human Services. Consensus on selecting EHR combined with reaching a consensus within the practice. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Cost identified several times for critical-access and rural hospitals Workflow and staffing challenges associated with maintaining an EHR. 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. 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. Ryu I, Hwang J-H. Role of distance learning self-efficacy in predicting user intention to use and performance of distance learning system. Thus, it is necessary to understand why users resist new EHR systems while focusing on user resistance behavior in a hospital setting. Cho, Y., Kim, M. & Choi, M. Factors associated with nurses' user resistance to change of electronic health record systems. The site is secure. 2017;101:1007. Self-efficacy for change has a negative effect on resistance to change. Our findings show that the relationship between perceived usefulness (path coefficient=0.01, P=0.923) and resistance to change was not significant and that the relationship between perceived ease of use (path coefficient=0.25, P=0.001) and resistance to change was significant. Accessibility 57,58 Hence, when implementing a new EHR, organisations should specifically set aside time for staff to attend training and . Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. This is important for practices where existing clinical processes are largely paper-based and computer use is minimal. In addition, except perceived value, colleagues opinion, self-efficacy for change, and organizational support among antecedents were effective in reducing resistance to change. Comput Inform Nurs. [14]. The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors' Health Outcomes: Cross-sectional Survey Study. Likely, there will be resistance to this change from the clinical and support staff all the way up to the board members and stakeholders. Mona Choi. 2016. sharing sensitive information, make sure youre on a federal The relationships among the four antecedents as well as perceived usefulness or perceived ease of use are derived from the Extended Technology Acceptance Model (TAM2) [26]. Yoo S, Kim S, Lee S, Lee KH, Baek RM, Hwang H. Int J Med Inform. Laumer S, Maier C, Eckhardt A, Weitzel T. Work routines as an object of resistance during information systems implementations: theoretical foundation and empirical evidence. Who are the key stakeholders during electronic health record (EHR On the scale of 7, the mean of user resistance behavior (mean=3.36, SD=1.13) was lower than that of resistance to change (mean=4.03, SD=1.38). Epub 2016 Jul 27. Kalkhajeh SG, Aghajari A, Dindamal B, Shahvali-Kuhshuri Z, Faraji-Khiavi F. BMC Prim Care. doi: 10.4258/hir.2020.26.1.68. 1989;13:31940. A technology acceptance model for empirically testing new end-user information systems: theory and results. Background: Although overt resistance behavior does not appear against a mandatory system in which users do not have any choice whether they use it or do not use it, covert resistance behavior could still occur [19, 20]. This study was approved by the Institutional Review Board (IRB) of the Yonsei University Health System (IRB number: Y-2019-0193). Here is all about challenges and solutions in EHR implementation in 2020. . eCollection 2022. Colleagues opinions have a positive effect on perceived usefulness. 2017 Aug;32(8):1004-1013. doi: 10.1080/10410236.2016.1196422. Barriers to Electronic Health Record System Implementation and The process of data migration . [14]. Self-efficacy for change was found to be the strongest predictor of user resistance behavior followed by perceived value and colleagues opinions; organizational support was the weakest. Otieno OG, Toyama H, Asonuma M, Kanai-Pak M, Naitoh K. J Adv Nurs. Methods: 2004;6(1):3255. 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]. Self-efficacy for change could reduce user resistance behavior by reducing users resistance to change and increasing perceived ease of use regarding a new system. These findings could help hospitals develop better EHR implementation strategies to reduce user resistance behavior among the nursing staff. The final questionnaire was reviewed by a professor of Korean language and literature to ensure that the grammar of the items was appropriate. Park YT, Kim D, Park RW, Atalag K, Kwon IH, Yoon D, Choi M. Association between Full Electronic Medical Record System Adoption and Drug Use: Antibiotics and Polypharmacy. 2020;26(1):6877. Before Technical concerns appeared 7.2% of all occurrences (9/125) [9, 12, 18, 2025]. YHC and MHK wrote the first draft and MC critically reviewed and revised the manuscript. Orlando: National Nursing Informatics Deep Dive Program; 2015. Providers acceptance factors and their perceived barriers to Electronic Health Record (EHR) Adoption. Thus, resistance to the implementation of a new EHR system would be lower if colleagues perceptions of the new system are favorable. 2021 Apr 8;5(4):e18764. There were 83 nurses (37.2%) with less than 5years of experience, 47 (21.1%) had between 6 and 8years of experience, while the majority, 93 (41.7%), had over 9years of experience. A statewide assessment of electronic health record adoption and health information exchange among nursing homes. Beasley, S and Girard, J. Office-based Physician EHR Adoption and Use in Southern US States. Training staff and physicians is necessary to make sure the EHR implementation succeeds and accomplishes the intended purpose. Resistance to information systems is not restricted to the refusal to use the system. That is, more nursing informatics education in nursing schools is recommended to reduce user resistance behavior as well as the proper user training at implementation in a hospital. Hence, this study has limitation to reveal causality on user resistance. If you encounter resistance during the EHR implementation, consider employing the following measures. This is concerning as having organisational support to invest in training and having empowerment to learn have been identified as critical factors to ensure the successful implementation of an EHR in health settings. Effect of Electronic Medical Record Quality on Nurses' Perceived Usefulness and Ease of Use. Integration was combined with degree of integration. An official website of the United States government. 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. Eur J Inf Syst. The .gov means its official. YHC and MHK conducted the literature search and acquired data. 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. Consequently, if sufficient organizational support is provided, resistance to change could be reduced. 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. sharing sensitive information, make sure youre on a federal Organ Behav Hum Decis Process. Meanwhile, self-efficacy is the internal mean method of perceived behavioral control [25]. Among 223 nurses, 81 (36.3%) were under 30years old and 71 (31.8%) were between 31 and 40years old. The square root of AVE for each construct exceeded the correlations between the construct and other constructs (Table 3) [35]. Table 3 shows the result of correlation analysis. Venkatesh V, Davis FD. The mean of perceived value (mean=4.59, SD=1.24) was highest among four antecedent variables followed by organizational support for change (mean=4.31, SD=1.09), self-efficacy for change (mean=4.10, SD=1.06), and colleagues opinions (mean=3.85, SD=1.13). Lack of interoperability stymies efforts of information governance and information sharing between organizations [29]. 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. The datasets analyzed in this study are available from the corresponding author on reasonable request. J Assoc Inf Syst. 2006;15(1):73101. 2023 BioMed Central Ltd unless otherwise stated. Both the formal nursing informatics education and the system training are required to increase nurses self-efficacy [13, 42], however significant nursing schools are still required more nursing informatics education in their curriculum [43]. Role-Based Training: Another effective training strategy is to tailor training sessions to the roles and responsibilities of your staff. 2016. Through a set of consensus meetings, the group of reviewers met to discuss their assessments. Perceived usefulness, perceived ease of use, and user acceptance of information technology. Understanding and mitigating uncertainty in online exchange relationships: a principal-agent perspective. Your electronic health record (EHR) implementation team, also known as the steering committee, can make or break the implementation process. Manag Sci. The findings of this study are overall consistent with Kim and Kankanhallis [13] based on status quo bias. This site needs JavaScript to work properly. Contract . Factors associated with nurses' user resistance to change of - PubMed Staffing your EHR implementation - EHRIntelligence 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 ]. How to overcome the challenges of EHR implementation - EHR in Practice The site is secure. MeSH Venkatesh V, Bala H. Technology acceptance model 3 and a research agenda on interventions. -, Lin C, Lin IC, Roan J. Epub 2013 Jul 1. Strudwick G. Predicting nurses use of healthcare technology using the technology acceptance model: an integrative review. Caitlin Kristof declares that she has no conflicts of interest. Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings. Healthcare informatics research. There are several limitations inherent to our review. DesRoches CM, Worzala C, Joshi MS, et al. 2020;57(3):103178. HHS Vulnerability Disclosure, Help Perceived ease of use showed the lowest mean (mean=3.78, SD=1.16) among 3 mediating variables. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 2012 Jun;36(3):1979-88. doi: 10.1007/s10916-011-9657-6. Identify Employee Computer Skills and Provide Basic Training. An official website of the United States government. Health information technology (HIT) and the use of electronic health records (EHRs) has increased substantially through efforts to achieve the following: reduce medical errors, provide more effective methods of communicating and sharing information among clinicians, lower national health care costs, better manage patient medical records, and improve coordination of care and health care quality [1, 2]. In general, members of the team should be enthusiastic, well-respected and forward thinking. PMC MIS Q. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems. A Clinical Support App for routine wound management: reducing practice variation, improving clinician confidence and increasing formulary compliance. Second, we empirically tested the research model in a hospital setting. IEEE, 2013. pp. PubMedGoogle Scholar. Assessment of organizational readiness to implement an - PLOS Health Inf Manag J. Implementing EHR systems in healthcare facilities has been met with an alarming rate of failure. While there is limited agreement regarding a theoretical model of user resistance behavior, a few prior studies have proposed models of user resistance. Electronic health record adoption among obstetrician/gynecologists in the United States: physician practices and satisfaction. Perceived usefulness has a negative effect on resistance to change. 2000;11(4):34265. Moreover, organizational support had a total effect of0.05 via perceived ease of use-resistance to change. Creating a Leadership Team for Successful EHR Implementation The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 8600 Rockville Pike 2022 Aug;19(5):1263-1275. doi: 10.1111/iwj.13868. Psychol Bull. To understand user resistance, it is necessary to understand user acceptance as well because they should not be regarded as mere opposites [14]. Mihui Kim received a scholarship from Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing. 2007;31:10536. This study aimed to investigate the factors associated with nurses' resistance to use the EHR system. doi: 10.1056/NEJMsa0900592. Factors associated with nurses' user resistance to change of electronic General characteristics were presented as means with standard deviation (SD) for continuous variables and as numbers and percentages for categorical variables. The .gov means its official. Investigating user resistance to information systems implementation: A status quo bias perspective. A descriptive correlational study was conducted with nurses working at four university hospitals in Korea using self-administered questionnaires to measure user resistance behavior, resistance to change, perceived usefulness, perceived ease of use, perceived value, colleagues' opinions, self-efficacy for change, and organizational support for change. MeSH N Engl J Med. Based on our experience, regardless of the chosen adoption approach, there are seven key steps providers need to take to overcome common roadblocks and ensure a smooth EHR system implementation. and transmitted securely. EHR Staff Training Plan.docx - EHR Staff Training Plan It 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]. Before Article Eley R, Fallon T, Soar J, Buikstra E, Hegney D. Barriers to use of information and computer technology by Australias nurses: a national survey. Conversely, self-efficacy for change (- 0.25), perceived value (- 0.21), colleagues' opinions (- 0.16), perceived ease of use (- 0.16), and organizational support for change (- 0.05) had indirect but no direct effects. This critical barrier only occurred in the literature once for the U.S., and only recently [27]. Organizational support (path coefficient=0.33, P<0.001) and self-efficacy (path coefficient=0.74, P<0.001) were effective on perceived ease of use in a positive manner. Venkatesh V, Morris MG, Davis GB, Davis FD. After collapsing/combining barriers, we had 39 barriers which occurred in the literature 125 times. Int J Med Inform. Springer Nature. Davis FD. Spil TA, Schuring RW, Michel-Verkerke MB. Self-efficacy for change and organizational support (determinants of perceived ease of use) correspond to computer self-efficacy and perception of external control, respectively, in the TAM3. Methods Inf Med. EHR systems are reducing medical errors, costs, and patients waiting time before receiving assistance, providing a more convenient system to archive patient data, and improving access to patient information and efficiency [1, 3,4,5,6,7]. doi: 10.1007/s10916-011-9656-7. The Federal Government has encouraged the adoption of EHRs through incentives found within the Health Information Technology for Economic and Clinical Health (HITECH) Act, which produced Health Information Technology Regional Extension Centers (RECs). How can I increase electronic health record (EHR) stakeholder Perceived value is defined by Kim and Kankanhalli as the perceived benefits relative to the costs of implementing a new EHR system [13]. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. We attempted to control for this bias through our many consensus meetings. Finally, the effect of perceived ease of use (path coefficient=0.08, P=0.14) on user resistance behavior was not significant; however, perceived usefulness (path coefficient=0.33, P<0.001) had a significantly negative effect on user resistance behavior, and resistance to change (path coefficient=0.65, P<0.001) had a significantly positive effect on user resistance behavior. If individuals perceive the change as valuable rather than costly, they are less likely to resist the change. J Med Syst. doi: 10.1016/j.pmrj.2017.02.007. Common method biases in behavioral research: a critical review of the literature and recommended remedies. Selecting the right people for an EHR implementation team is a critical step in a successful implementation. Complexity of meeting meaningful use criteria and difficulty meeting eligibility criteria were grouped under eligibility criteria. The site is secure. During these meetings we would share observations and ensure that we were all looking for the same things. However, it is still a useful factor to consider when seeking to reduce user resistance behavior, as is resistance to change, although perceived ease of use is not the only factor influencing user resistance behavior. Here, we've put together five effective EHR training tips to get staff in your practice adequately trained and comfortable on a new system: 1.
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