Dynamics of EHR Implementations

摘要

In this paper we endeavor to develop a theory to explain the dynamics of an Electronic Health Record (EHR) implementation. We base our theory on a well-established system dynamics model of improvement evolution-the model by Repenning and Sterman (RS)-with modifications that incorporate aspects of the more detailed Affordance Actualization (AA) theory. To do so we develop two simulation models: a small generic model for conceptualization and a larger more sophisticated model for operational policy design purposes. The "small" model can explain general EHR implementation dynamics producing success or failure in healthcare (HC) settings. However, it is not sufficient for comprehensive policy design and analysis. The "big" model, on the other hand, is flexible enough to allow users to design and test their own policies. Experimentation with this model revealed that a structural change of the model is needed for the EHR implementation to be successful. We show that this change-a strong connection between organizational benefits and individual benefits-is key for successful EHR implementation. Specifically, it is important to adjust the reward scheme for physicians to make the implementation successful.