Learning from within to ensure a successful implementation of an electronic health record.

Implementation of an electronic health record has multiple facility-wide challenges affecting all direct care providers. Because the dialysis unit and emergency department had already undergone transition with differing electronic systems several years before, could anything be learned from these past experiences to inform the future institution-wide implementation? Utilizing focus groups and surveys, recurring themes emerged: "It will take one hundred charts"; allowing for "self-discovery" of individual learning progression; establishing and communicating "clear processes" for use of the electronic record; and ensuring adequate support to facilitate a "customer-focused" approach in learning how to utilize electronic documentation. Although training related to the electronic health record was discussed in all focus groups, training was not described as a main concern, which challenged our initial presumptions that education was the key resource for a successful change. Three of the four themes uncovered in this study are not unique and corroborate the findings in other studies. "Clear processes" is a new theme not previously identified. These themes with recommendations were presented to the electronic health record design team to assist with the hospital-wide implementation.