Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

Table 2

Personal and system-related barriers challenging EHR implementation.

	Personal barriers	System-related barriers
Provider-level barriers	Difficulty changing work patterns; “Our workflow has to change completely” ~Manager; Lack of computer skills; (i) “Well one of the biggest barriers is lack of PC skills.” ~Manager; (ii) “I also have a difficult time typing and not looking at my patients.” ~Physician; Threat of retirement; “They are ready to make the move, they've been thinking about it for a while - and they just end up retiring.” ~IT Professional	Providers wanting customization; “The providers wanted a lot of customization. Things that maybe the system didn't have the capacity to do. Or they wanted everything customized to their department or to their clinic.” ~IT Professional; Loss of productivity, especially initially; (i) “It slows them down” ~Physician; (ii) “There were a significant number of common tests that we ordered that were not programmed before we went live and there were the names of some of the tests were not standard and so led to a significant amount of inefficiency.” ~Physician; Loss of ability to document in detail; “I end up doing very abbreviated sentences and not perhaps, including some of the details because it’s too long.” ~Physician
Organization-level barriers	General resistance to change; “We don’t want to do that because we’ve been doing it this way! We’ve been doing it this way for ten years!” ~Manager; Value of sharing data not seen; “We haven’t yet achieved the value of the sharing of data” ~Physician; IS support not perceived as sufficient; “And they weren’t able to respond in real time … The help people had no ability to do anything other than to submit a ticket and then it would go to the programmers and then when they got to it they would put it in.” ~Physician	System goes down; (i) “When the system goes down for any reason, it’s not very nice.” ~Manager; (ii) “It’s crippling … You can’t really even see patients because you don’t have anything. You don’t have a med list, you don’t have a problem list, how do you see a patient?” ~Manager; System has limitations; (i) “The query system for me is slow, it’s more cumbersome.” ~Manager; (ii) “being in that system for some of our patients and then having to go to (another system) for some of our patients.” ~Executive; Challenges managing system updates; “There’s so much new to add. We basically, when we get an upgrade, we have to sit down and decide how much of it we can put in because even if we can test it all, we can’t train everybody on all of it.” ~Executive