Document Type


Degree Name



Department of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Implementation of an electronic health record (EHR) is a complex process which is not complete until physicians use the system in direct patient care.(Kaplan & Harris- Salamone, 2009; Pare, Sicotte, & Jacques, 2006) Failure to achieve physician adoption of a new EHR creates organizational risk, which can range in magnitude from failure to attain desired benefits (such as improving patient safety or gaining competitive market advantage) to threatening the financial viability of the institution.(Conn, 2007) Ensuring physician adoption of a new EHR is often under the direction of vendor consultants, institutional leadership, and third-party contractors. Approaches to adoption by consultants and contractors vary, as an individualized implementation approach is considered a marketing tool representing a competitive differential advantage.(Cerner Corporation, 2013; Dearborn Advisors; Dearborn Advisors, 2013) Institutional leadership may take varying approaches to adoption for many reasons such as biases acquired in previous experiences, lack of experience or training, or a desire to tailor an approach to local conditions. Although some variation in approach is expected due to differences in initial client state, unexplained variation in adoption practice might increase the possibility of inferior outcomes and increased cost. The use of a consistent, evidencebased approach may result in more consistent and more successful physician adoption of EHRs.(Stetler, McQueen, Demakis, & Mittman, 2008) Focusing on discovering items that could be expressed as specific activities or outcomes, we performed a thematic

analysis of the physician adoption literature, then combined the resulting themes (and the resulting operational items) with the experience-derived opinions of a panel of experts. The resulting set of items represents an operationally-focused list of critical success factors for physician adoption. By making these specific and detailed enough, they can be crafted into a framework or checklist. Such a tool could guide both inexperienced and experienced implementers to more consistent physician adoption of newly-implemented EHRs, while providing a springboard for further research on adoption best practices by helping to define the orthogonal dimensions of the adoption conceptual space.




School of Medicine



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