Beyond the ‘Go-Live’: why context matters in EHR implementations

Electronic Health Records (EHR) systems are essential to the daily work of healthcare providers. However, the implementation or ‘go-live’ of a new EHR remains a costly and challenging endeavour. 1–3 Two recent editors’ choice papers in BMJ Health & Care Informatics examined how newly implemented EHR systems affect usability, workflow and clinical outcomes. In a cross-sectional survey of 1424 health professionals, Lohmann-Lafrenz et al4 compared the perceived usability of a newly implemented EHR across various occupational groups (eg, medical doctors and therapists) and clinical contexts (eg, oncology and laboratory medicine) as well as examined the relationships between EHR usability and provider burnout, insomnia and turnover intention. In this context, usability refers to ‘the extent to which technology can be used to achieve specific goals with effectiveness, efficiency and satisfaction’.4 Williams et al5 conducted clinical observation and analysed the actual use patterns of the Barcode Medication Administration (BCMA) system, a service available in their newly implemented EHR. While the scope and methods of these two papers4 5 differ, their synergistic findings offer a unified and convincing lesson that EHR implementations are challenging because we often do not adequately account for the variations in the clinical contexts where the implementations occur.