Adoption of Electronic Health Records

Electronic Health Records Assignment Requirements

Application: Adoption of New Technology Systems (Electronic Health Records)

As a nurse, you can have a great impact on the success or failure of the adoption of Electronic Health Records (EHRs.) It is important for nurses to understand their role as change agents and the ways they can influence others when addressing the challenges of changing to a drastically different way of doing things.

Everett Rogers, a pioneer in the field of the diffusion of innovations, identified five qualities that determine individual attitudes towards adopting new technology (2003). He theorized that individuals are concerned with:

• Relative advantage: The individual adopting the new innovation must see how it will be an improvement over the old way of doing things.
• Compatibility with existing values and practices: The adopter must understand how the new innovation aligns with current practices.
• Simplicity: The adopter must believe he or she can easily master the new technology; the more difficult learning the new system appears, the greater the resistance that will occur.
• Trialability: The adopter should have the opportunity to ‘play around’ with the new technology and explore its capabilities.
• Observable results: The adopter must have evidence that the proposed innovation has been successful in other situations.

Note: You are not required to purchase Rogers’ book or pursue further information regarding his list of five qualities. The information provided here is sufficient to complete this Assignment. The full reference for Rogers’ work is provided below the due date on this page.

For this Assignment, you assume the role of a nurse facilitator in a small hospital in upstate New York. You have been part of a team preparing for the implementation of a new electronic health records system. Decisions as to the program that will be used have been finalized, and you are now tasked with preparing the nurses for the new system. There has been an undercurrent of resistance expressed by nurses, and you must respond to their concerns. You have a meeting scheduled with the nurses 1 week prior to the training on the new Electronic Health Record system. Consider how you can use the five qualities outlined by Rogers (2003) to assist in preparing the nurses for the upcoming implementation.

To prepare:

• Review the Learning Resources this week about successful implementations of EHRs.
• Consider how you would present the new EHR system to the nurses to win their approval.
• Reflect on the five qualities outlined by Rogers. How would addressing each of those areas improves the likelihood of success?

To complete:

Write a 3- to 5-page paper which includes the following:

• Using Rogers’ (2003) theory as a foundation, outline how you would approach the meeting with the nurses. Be specific as to the types of information or activities you could provide to address each area and include how you would respond to resistance.
• Analyze the role of nurses as change agents in facilitating the adoption of new technology.

This Assignment is due by Day 7 of Week 6.

Reference:
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.

Solution 1

Adoption of Electronic Health Records (EHR) Technology

Introduction

With an increase in technology, all sectors including the health sector have been forced to embrace new forms of technology to promote their efficiency and effectiveness in terms of offering their services. However, introduction of new technology in health institutions proves to be a highly involving task as such technology is bound to meet resistance at some point owing to the fact that some individuals are less receptive to change as compared to others. As such, the innovation theory diffusion provides a framework through which individuals can promote the adoption of new technology into health care environments through providing a clear understanding of the factors that drive perception towards such change. Use of the theory in driving change allows for the facilitator to modify the innovation and to present it to the adopters in a form that meets their needs. With this in mind, it is clear that introduction of the Electronic Health Records (EHRs) technology in the health organization will not be immediately accepted among all the nurses. As the nurses seek more information about the technology, it is the role of the facilitator to make such information available in a way that will encourage adoption of the technology. According to Rogers, the rate of adoption of new technology is influenced by five significant attributes including relative advantage, compatibility, complexity/simplicity, trialability, and observability, which are important for facilitators to adopt in persuading the adopters.

Relative advantage

Rogers (2003) clearly identified relative advantage as the level to which an individual towards whom a new idea has been introduced in the place of an older one, views the new one as more effective than the older one. Cost and social status motivation are the major elements that come into play in the definition of relative advantage (Rogers, 2003). For instance, status is an important motivational factor for facilitators of an idea or technology and the early adopters. Nevertheless, less significance is given to status by the late majority and the laggards. Moreover, individuals within the organization may adopt a new idea or technology according to which category it belongs to. Basically, there are two categories of innovations, including incremental innovations and preventative innovations. In this case, preventive innovations are any ideas that are introduced within the organization to reduce probability of occurrence of any future event that has been predetermined. On the other hand, incremental innovations involve short-term benefits. In any case, individuals are more receptive to incremental innovations as compared to preventive innovations. Through presentation of the immediate benefits of the EHR technology, the nurses are likely to be more receptive to the innovation (Carlfjord, Lindberg, Bendtsen, Nilsen, & Andersson, 2010). It is thus important to clearly outline the benefits of the technology including how much it would reduce medical errors and facilitate coordination and communications of the roles and responsibilities of the different health personnel. This way, the nurses would be convinced of the change of effect that they are likely to experience in their practice upon adoption of the technology.

Complexity/ Simplicity

Simplicity is another factors that greatly determines the rate at which a new innovation would be adopted within an organization. In this case, simplicity refers to the extent to which the adopters perceive the innovation as easy to understand and to use (Sahin, 2006). Rogers suggested that a positive correlation exists between the level of simplicity of an innovation and the rate at which it is adopted. When it comes to the introduction of the EHR technology to the nurses, one of the issues surrounding simplicity would involve how easy it would be for the nurses to shift from the initial techniques of record sharing and keeping. Complexity in terms of using the new technology may increase the level of resistance among the nurses. However, such a challenge can be countered effectively through selecting EHR hardware and software that are user-friendly. Furthermore, provision of the nurses with instructions in understandable and simple language and the use of demonstrations and tutorials to create familiarity with the technology would introduce an aspect of ease in use of the technology among the nurses and encourage adoption. Training programs and sessions about EHR application would also allow for the establishment of a sense of simplicity among the nurses through allowing for acquisition of the necessary skills and expertise in the use of the technology (Bates, 2010). Such measures would allow the nurses to overcome their skepticism about the use of the technology and to develop and interest towards exploring its provisions.

Compatibility

Compatibility involves how consistent an innovation or idea is with the needs of the adopters, their existing, values, and past experiences (Rogers, 2003). It is important to note that in any organization, as much as the staff aim at accomplishing the organizational goals, they also have their own goals which they intend to accomplish in line with their professional or personal life. Any idea or innovation that is introduced to the organization thus has to be considerate of both the organizational needs and the needs of the adopters. How the nurses embrace the EHR technology would be highly dependent on how compatible the technology is with the needs of the individual nurses. Any innovation has its influence on the values, views, opinions, and beliefs of the nurses in line with their practice. Thus, in order to encourage the nurses to adopt the technology, it is important for the facilitator to help the nurses to identify the benefits of the technology not just to the organization but also to needs of the nurses in terms of professional growth (Gagnon, Nsangou, Payne-Gagnon, Grenier, & Sicotte, 2014). It is only upon identification of the compatibility between what the technology is offering and the needs of the adopters that the nurses will be quick to adopt the technology.

Trialability

Rogers (2003) defined trialability as the extent to which an innovation can be experimented by the adopters. The more a given idea or innovation is tried in terms of application, the more likely that such a technology will be adopted. It is through trying an innovation that the adopter is provided with the opportunity to explore the provisions of such technology, modify it, and re-invent it, thus increasing chances of adoption of a version that is more acceptable to the staff (Rogers, 2003). In the case of nurses, trialability would be enhanced through promoting application of the EHR system among them and encouraging independent exploration of the technology. Practical training of the nurses in the use of the technology and allowing them to try its application would increase familiarity with the technology and the rate of adoption among nurses. Through organizing trial sessions, the nurses would not just learn about but experience the advantages of the technology, an aspect that would highlight more reasons as to why they should embrace the technology.

Observability

Observability is also an important factor to determine when persuading nurses to adopt the EHR technology. For an innovation to be easily adopted, the adopters ought to see its results and quantify them (Cresswell, Bates, & Sheikh, 2013). Continued realization of the benefits of the technology among the nurses would increase their interest in application of the technology and thus the rate of adoption. Thus, the facilitator ought to expose the nurses to evidence of the benefits of the technology as observed in other institutions. As such, the facilitator may organize visits to other institutions that have successfully applied the technology. On the other hand, the facilitator may invite administrators of the technology in other institutions to talk to and encourage the nurses of the effectiveness of the technology based on their experiences using it.

Conclusion

It is clear that for innovations to be adopted within an organization, the facilitator has to effectively persuade the adopters that the technology is worth adoption. It is thus important to ensure that the nurses have a clear understanding of the benefits that come with the adoption of the EHR technology through clearly reviewing and presenting aspects of relative advantage, compatibility, and simplicity, and encouraging trialability while promoting observability. It is important to ensure that the nurses clearly understand what it takes to ensure the success of the technology through proper training and communication of the aspects of the technology.  

References

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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839327/

Carlfjord, S., Lindberg, M., Bendtsen, P., Nilsen, P., & Andersson, A. (2010). Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory. BMC Family Practice, 11(60), 1-11.

Cresswell, K. M., Bates, D. W., & Sheikh, A. (2013). Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of American Medical Information, 20, e9-e13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933616/

Gagnon, M.-P., Nsangou, É.-R., Payne-Gagnon, J., Grenier, S., & Sicotte, C. (2014). Barriers and facilitators to implementing electronic prescription: a systematic review of user groups’ perceptions. Journal of American Medical Information Association, 21, 535–541. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994867/

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press. https://books.google.co.ke/books/about/Diffusion_of_Innovations_5th_Edition.html?id=9U1K5LjUOwEC&redir_esc=y

Sahin, I. (2006). Detailed Review Of Rogers’ Diffusion Of Innovations Theory and Educational Technology-related Studies Based on Rogers’ Theory. The Turkish Online Journal of Educational Technology, 5(2), 14-23. http://tojet.net/articles/v5i2/523.pdf

Solution 2

Introduction

Upon introduction of new technology or ideas in any organizational setting, most of the parties who are expected to adopt the technology hold high levels of uncertainty about the innovation. Rogers maintains that for the innovation to be fully embraced by those individuals who are initially uncertain, it is important for the facilitator of the innovation to expose them to knowledge that would promote their acceptance of the idea or technology. Rogers presents five major attributes that would present an innovation in a manner that is more appealing to the adopters and thus enhance adoption. As a nurse facilitator, it is important for these attributes to be used to ensure the adopters understand the Electronic Health Records (EHR) technology in order for them to embrace it with the required level of optimism.

Relative advantage

According to Rogers, relative advantage refers to the level by which the introduced innovation, be it a technology or idea, is better in comparison with the technology or idea that it is to replace (Rogers, 2003). As such, an idea that would appear to the adopters as more beneficial than the initial idea is highly likely to attract more of the adopters within a shorter period as opposed to one that presents less benefits. Relative advantage has two major elements, which include social status motivation and cost innovation aspects. For instance, those categories who adopt innovations during the early stages are mostly status motivated, while those who tend to adopt innovations during the late stages do not find any significance in status. Under relative advantage, Rogers groups innovations into either non-preventive (incremental) and preventive innovations (Rogers, 2003). Incremental innovations offer immediate benefits and are thus highly likely to be adopted within the shortest period as the adopters are eager to experience the noted benefits. On the other hand, preventive innovations are innovations that are adopted by individuals to reduce the possibility of an event to take place in the future. The benefits of such ideas are seen as futuristic and thus they are adopted at a slower rate as the adopters do not anticipate the change that the ideas will have on their practice. As a nurse facilitator, it is important to help the nurses realize the immediate benefits of the EHR technology to their practice as this would enhance the chances of adoption (Gagnon, Nsangou, Payne-Gagnon, Grenier, & Sicotte, 2014). Exposing the nurses to information concerning the benefits of the technology throughout talks, handouts, and visits to institutions where the technology has already been implemented would allow for reduction of uncertainties concerning the benefits of the technology and thus hasten adoption.

Compatibility

In his diffusion theory of innovation, Rogers (2003) maintained that compatibility is the extent to which an idea or innovation is viewed as being coherent with the previous experiences, values, and needs that exist among the expected adopters. Lack of compatibility between the introduced innovation and the needs of the adopters would heighten the level of uncertainty and hence inhibit adoption. It is important to note that any innovation that is introduced to nurses has an influence on their views, values, and beliefs about nursing. As such, for them to adopt the EHR technology, it ought to be compatible with their needs, beliefs, and values (Bates, 2010). Compatibility incorporates various factors ranging from the name of the innovation to its actual meaning and components. As such, it is important for the facilitator to engage the adopters in developing a clear understanding of the meaning of Electronic health record and what entails such records. It is important to present the technology to the nurses from a benefits perspective, by reviewing their needs and helping them understand how the technology helps in meeting such needs, upholding their values, and maintaining their beliefs.

Simplicity

Simplicity is the extent to which a given innovation is viewed as easy to comprehend and apply. The more complex an innovation is, the more negatively it affects the rate of adoption (Rogers, 2003). Adopters of any innovation need to be assured that the innovation would not add to the difficulties and challenges they are facing in their practice. As such, in the case of the nurses, if the EHR will require the change of their practice approaches, then the rate of adoption will undoubtedly be slow. Nevertheless, it is important to understand that the EHR technology does not alter the nursing practice, but instead enhances it. It is important for the facilitator to encourage procurement of easy to use EHR Hardware and Software. In addition, it is important to organize training sessions for the nurses as it would help them with familiarizing with the technology and would also allow the nurses to ask any questions concerning their uncertainties of using the technology (Lee, 2004). This would allow for addressing of all the causes of uncertainties in the application of the technology and in increasing the confidence of the nurses in terms of use of the technology.

Trialability

Rogers noted the trialiability of any innovation to its adoption, especially among early adopters. The individuals interact with an idea, the more they learn about it and fill any information gaps that they previously had, leading low uncertainty and increased rate of adoption (Sahin, 2006). It is significant to note that through trying the new idea, the adopters may contribute to its development and thus reinvent, leading to a refined new idea as the final product. This contributes to the general growth of ideas and the knowledge base. One of the methods that the facilitator can use in promoting adoption of the EHR by nurses is by using practical demonstrations when training the nurses on the use of the technology. Another approach would be to allow the nurses to interact with the technology as soon as they can as this would allow for learning among the adopters and the spread of positive word of mouth about the technology to the rest of the nurses (Lee, 2004). Such positive feedback would facilitate further adoption of the technology.

Observability

According to Rogers (2003), observability involves the seeing of results of a given innovation in other persons (Lovejoy, Demireva, Grayson, & McNamara, 2009). As such, the adopters of a given technology look for results that they can quantify and are more motivated to adopt a technology that has been seen to succeed than a technology that has not yet been tried elsewhere. As such, it is important for the facilitator to ensure that the nurses are exposed to examples of cases in which the EHR technology has been used and succeeded (Gagnon, Nsangou, Payne-Gagnon, Grenier, & Sicotte, 2014). This could be achieved through partnering with an institution that has already implemented the system in order to allow for information sharing concerning the successes of the technology. The facilitator could establish a community of practice that would interact through a blackboard, involving both institutions. This would allow for proper sharing of information concerning the technology and role modelling in terms of its applicability, thus getting rid of adopter uncertainties and promoting adoption.

Conclusion

Evidently, proper persuasion is key to making an innovation successfully diffuse across an organization. Such persuasion requires a proper understanding of the provisions of the innovation and the needs of the potential adopters in order to relate the two. The nurses should just be helped to understand the positive influence that the technology will have on their practice using the attributes of relative advantage, compatibility, complexity, trialability, and observability. These attributes enhance the aesthetics of any idea, thus presenting it in a more desirable and admirable manner.

References

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.

Gagnon, M.-P., Nsangou, É.-R., Payne-Gagnon, J., Grenier, S., & Sicotte, C. (2014). Barriers and facilitators to implementing electronic prescription: a systematic review of user groups’ perceptions. Journal of American Medical Information Association, 21, 535–541.

Lee, T. T. (2004). Nurses’ adoption of technology: application of Rogers’ innovation-diffusion model. Applied nursing research, 17(4), 231-238.

Lovejoy, T. I., Demireva, P. D., Grayson, J. L., & McNamara, J. R. (2009). Advancing the practice of online psychotherapy: An application of Rogers’ diffusion of innovations theory. Psychotherapy: Theory, Research, Practice, Training, 46(1), 112-124.

Rogers, E. M. (2003). Diffusion of innovations. New York: Free Press.

Sahin, I. (2006). Detailed Review Of Rogers’ Diffusion Of Innovations Theory and Educational Technology-related Studies Based on Rogers’ Theory. The Turkish Online Journal of Educational Technology, 5(2), 14-23.