Moving from good to great in ambulatory electronic health record implementation

Despite a good general understanding of the need to ensure provider adoption and use of electronic health record (EHR) systems, many implementations fall short of expectations, and little is known about effective approaches in the ambulatory care area. We aimed to comprehensively study and synthesize best practices for ambulatory EHR system implementation in healthcare organizations, emphasizing strategies that maximize physician adoption and use. Following an extensive literature review, we held 47 key informant interviews with representatives of six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR system implementation. We interviewed both administrative and clinical informants in order to improve our understanding of ambulatory EHR implementation from both perspectives. We found that while all 6 sites studied were reported to have strong EHR implementation practices, we were able to characterize "good" versus "great" approaches across the sites. Specifically, "great" implementations included a key element focused on optimization and improvement over time that helped healthcare organizations support physician adoption and use of the EHR system. The "great" implementation approaches we saw also included explicit considerations of improved data capture and quality of care in their focus on optimization in order to maximize the value of the EHR.