Example 8: User Frustration With Frequent EHR Updates

Issues Encountered

A behavioral health and substance abuse facility implemented a new EHR. Many staff members were frustrated by the seemingly constant changes and updates to the system. One staff member said that she struggled to keep up with the "continual upgrades and modifications" and that she feels like the "target is always changing." Implementation of the EHR led to a decrease in staff morale, and a number of staff members left as a result.

Finding a Solution

An interdisciplinary group of clinicians, administrators, and IT staff worked together to make the implementation and maintenance of the EHR less taxing on the clinical staff. Their first solution was to focus on training and supporting users as they learned how to use the EHR. One user said that simply "having someone available to take calls and trouble shoot helped the most." Their second solution was to take a more gradual approach for updating the system. One member of the IT staff said: "We have learned to make changes in versions and we try not to implement any changes during some periods, so that staff members feel like they can manage the change." And his advice to futureEHR implementers was: "Try to keep changes to a minimum. Improvements still mean change and that is the most common complaint — that staff cannot learn anything because the system is continually changing..."

Lesson Learned: 
  • Training and support are essential to EHR success — beginning with implementation and continuing with each upgrade.
  • Introduce system changes in versions (phases) and allow sufficient time between changes for staff to adapt to the new system.

This material was derived from responses to a membership survey about unintended consequences that the American Health Informatics Management Association (AHIMA) conducted in 2009. For further information, contact Spencer Jones at the RAND Corporation at sjones1@rand.org.

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