Factors that present challenges to healthcare staff during EMR implementation : an integrative review of literature

Abstract

Over twenty years ago, the Institute of Medicine began urging the medical community to embrace the conversion from paper-based charting to electronic medical records (EMR) (National Assembly on School Based Health Care [NASBHC], n.d.). However, it has only been in recent years following the offering of financial incentives by the Department of Health and Human Services that hospitals and doctors' offices have begun the transition in documentation to an EMR (Haupt, 2011). As of the year 2009, it was reported that only 11.9% of US hospitals were using either a basic or comprehensive EMR, and only 2% of hospitals were using an EMR robust enough to comply with the federal government's "meaningful use" criteria (Jha DesRoches, Kralovec, & Joshi, 2010). One reason that so few healthcare organizations have completed the transition to an EMR system of documentation is due to the tedious implementation process and the challenges that arise during this process. The purpose of this integrative review of literature is to explore the factors that present challenges to healthcare staff during EMR implementation in healthcare organizations. This integrative review was performed by mining relevant literature from predetermined databases and all reference lists of the located literature. A total of 26 articles met the predetermined inclusion criteria. The results indicated that the factors that present challenges can be organized into two themes: personal/professional factors and organizational factors. Personal/professional factors include adequate time, inadequate computer skills, workflow disruption, user friendliness, negative impact on patient-provider relationship, security, and poor understanding of the EMR benefits. Organizational factors include cost, inadequate EMR standardization, information technology issues, and issues with implementation. After determining these factors that present challenges to healthcare staff during EMR implementation through careful literature review, the reviewer concluded that a standardized plan for successful EMR implementation in all healthcare settings including remedies for these challenges should be formulated. This standardized plan would offer healthcare organizations the best chance for smooth EMR implementation into practice for the staff, patients, and organization as a whole.