Organizational learning in the implementation and adoption of national electronic health records: Case studies of two hospitals participating in the national programme for information technology in England

摘要

Objective: To explore the role of organizational learning in enabling implementation and supportingadoption of electronic health record systems into two English hospitals.Methods and setting: In the course of conducting our prospective and sociotechnical evaluation of theimplementation and adoption of electronic health record into 12 early adopter hospitals across England,we identified two hospitals implementing virtually identical versions of the same off-the-shelf software(Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case studybasedanalysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementationexperiences. Data included the following: 63 in-depth interviews with various groups of internal and externalstakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysiswas both inductive and deductive, the latter being informed by the sociotechnical changing theoreticalperspective.Results: Although Alpha and Omega shared a number of contextual similarities, our evaluation revealedfundamental differences in visions of electronic health record and the implementation strategy betweenthe hospitals, which resulted in distinct local consequences of electronic health record implementationand impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits tothe organization as a result of the introduction of electronic health record, such as speeding-up tasks.Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learningwas at the heart of this difference.Conclusion: Despite the turbulent overall national roll out of electronic health record systems into theEnglish hospitals, considerable opportunities for organizational learning were offered by sequential deliveryof the electronic health record software into early adopter hospitals. We argue that understanding theprocess of organizational learning and its enabling factors has the potential to support efforts at implementingnational electronic health record implementation endeavors.