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Week 5: Electronic Health Records

To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that within 5 years all of America's medical records are computerized. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests.

—Barack Obama (2009)

President Obama’s quote epitomizes the urgency surrounding electronic health records (EHRs). In February 2009, the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act designated nearly $26 billion dollars’ worth of funding to promote the rapid adoption and meaningful use of EHRs (U.S. Department of Health & Human Services, 2012). Despite this surge of support for the adoption of electronic health records, many challenges to their implementation have persisted in the subsequent years.

This week, you explore the implementation of electronic health records. You consider the benefits and challenges of the implementation process and how nurses can fulfill the role of change agents.

Learning Objectives

Students will:

  • Appraise strategies for overcoming barriers to the implementation of electronic health records

  • Apply Rogers’ Diffusion of Innovation to the implementation of an electronic health record

  • Analyze the role of nurses as change agents

Discussion: Electronic Health Records

Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.

In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.

To prepare

  • Review the Learning Resources focusing on the implementation of EHRs in an organization. Reflect on the various approaches used.

  • If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?

  • Reflect on the reactions of others during the implementation process. Were concerns handled effectively?

  • If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.

  • Search the Walden Library for examples of effective and poor implementation of EHRs.

Questions to be answered

1.Write an overview of at least three challenges in the implementation of electronic health records and provide an example of each challenge.

2. Develop strategies for addressing each challenge based on what has been demonstrated to be successful. Cite your resources.


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Electronic Health Records

Health records are a vital part of the overall health care practice. They provide a history of treatment for individual patients and also inform future decisions, policies and practices in a health care facility. The use of technology in health records management has become vogue. This is because technology makes it easier and faster to keep and retrieve records. It also reduces the bulk that is characteristic of old paper filing systems. According to Bates (2010), proper use of electronic health records (EHRs) could help minimize care costs, enhance quality and safety standards in health care. However, as Cresswell and Sheikh (2009) observe, the implementation of EHRs is fraught with many challenges. This paper explores the challenges faced by facilities in trying to implement EHRs. It also suggests strategies that can be used by hospitals to address the said challenges.

Challenges in the implementation of electronic health records

There are three major types of challenges to effective EHR implementation. Among these, cost-related challenges are the most obnoxious barriers, followed by workforce and staffing, and then technical challenges (Gabriel, Furukawa, Jones, King & Samy, 2013). The cost of implementation of EHRs is quite high as it requires a complete set of an appropriate broadband system and most hospitals do not have the financial base to implement the entire system at once (Gabriel et al., 2013). On the other hand, challenges relating to the workforce include workflow changes, availability of technology experts, low acceptance and use of EHRs among health care personnel, lack of training and poor leadership in EHR implementation. Among these challenges, the leading barrier to implementation of EHRs is resistance to change (Ajami & Arab-Chadegani, 2013). Lastly, in the group of technical challenges, the most obvious is the security risks that come with IT applications. This risk demands that hospitals regularly conduct upgrades to detect and thwart potential hacking or electronic intrusion into their systems. Other challenges include inadequate support from EHR supplier, mismatch of the type of EHRs selected with nature of services being rendered, and unreliable broadband quality (Gabriel et al., 2013).

Strategies for addressing the challenges

First, on the issue of costs, there are many grants that are given both through government and private sector channels to support implementation of EHRs (Gabriel et al., 2013). However, facilities must meet the threshold for receiving such grants. They should develop workable proposals and elevate their sense of accountability in their use of granted funds for EHR implementation. Second, acceptance is key to successful implementation of EHRs (Ajami & Arab-Chadegani, 2013). Therefore, facilities should strive to garner the support of health care practitioners. One way to achieve this is through peer training by those who are already enthusiastic about the technology. Acceptance can also be achieved through awareness training and by offering incentives to those who use EHRs in their stations. Lastly, for sustainability of EHRs, the training needs of clinicians must be met. One unique feature of technologies is that they keep changing. This means that providers must conduct regular upgrades. These upgrades should be accompanied with updating of skills for all clinicians.


EHRs provide a systematic approach to the management, access and use of health care information. Unfortunately, numerous challenges thwart the proper implementation and use of EHRs. The leading challenges are related to costs, acceptance, training and security concerns. Health care providers have many avenues at their disposal to address these challenges. The government and other agencies provide grants and incentives to support EHRs adoption. As such, providers should take advantage of such grants to implement and maintain EHRs and offer training for their personnel to enhance user ability and acceptance.




Ajami, S., & Arab-Chadegani, R. (2013). Barriers to implement Electronic Health Records (EHRs). Master Sociomed, 25(3), 213-215.

Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174-176.

Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.

Gabriel, M. H., Furukawa, M. F., Jones, E. B., King, J., & Samy, L. K. (2013). Progress and Challenges with the Implementation and Use of Electronic Health Records among Critical Access Hospitals. ONC Data Brief No. 12. The Office of the National Coordinator for Health Information Technology.

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