Implementation of an electronic health record

Implementing an electronic health record along with computerised provider order entry and clinical decision support is hard. Integrating these advanced technologies into a complex and rapidly changing healthcare delivery environment is a major task, but the associated cultural, process, and change management obstacles make the task even harder. Furthermore, the challenges and costs often accrue long before any real value of the effort is seen.

The current controversy regarding the NHS effort to implement a system-wide electronic health record is a good case study of how difficult these initiatives can be.1 When health systems encounter the associated and inevitable difficulties, the natural inclination is to question whether the aggravation and effort is worthwhile. This is clearly at the core of the debate in the United Kingdom regarding the NHS effort. At such times, leaders who are seriously interested in improving the safety, quality, efficacy, and cost of care need to do what all good leaders do—pause, carefully assess the situation, and learn from the experience of their efforts as well as that of others. They should then use this knowledge to determine how to achieve the ultimate goals of the initiative—better …