Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 17, 2020
Date Accepted: Mar 16, 2021
User perspectives on barriers and facilitators to the implementation of electronic health records in behavioral hospitals: A qualitative study
ABSTRACT
Background:
Despite the rapid adoption of electronic health records (EHRs) thanks to the reimbursement program of the US government, the adoption of EHRs in behavioral health hospitals continues to lag behind that of other hospitals, and there remains a lack of evidence regarding barriers to and facilitators of the implementation of behavioral healthcare electronic health records (bhEHRs).
Objective:
The aim of this study was to analyze the experience of behavioral health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of bhEHRs.
Methods:
In this qualitative study, we interviewed physicians, nurses, pharmacists, behavioral health clinicians, and administrative professionals separately at 4 behavioral health hospitals in the US. We conducted semistructured interviews (N= 43) at behavioral health hospitals involved in the adoption of bhEHRs. We used purposeful sampling to maximize diversity. Transcripts were coded and analyzed for emergent domains. Exploratory data analysis was applied.
Results:
Content analyses revealed 4 barriers and 4 facilitators. The most important barriers to implementing bhEHRs were the low level of computer proficiency among nurses, the complexity of the system, alert fatigue, and resistance due to legacy systems. These barriers led to poor usability and acceptability and a distrust of the system. Among the major facilitators identified were well-executed training programs, improved productivity, better quality of care, and the good usability of the bhEHR system.
Conclusions:
Healthcare professionals are keen to use bhEHRs, which may enhance their work productivity and interprofessional collaboration. Routine education for end users is the essential starting point to provide support for decision making and successful implementation of bhEHRs. When adopting bhEHRs, managers need to focus on common practices in behavioral health hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of behavioral healthcare into the system.
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