{"title":"“可怕的东西。“我们已经有了”:医院员工对新的电子健康记录的反应及其对员工福祉的影响——一项定性研究","authors":"Eivind Sæthre , Solveig Osborg Ose , Steinar Krokstad , Sigmund Østgård Gismervik","doi":"10.1016/j.ijmedinf.2025.106039","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Electronic Health Record (EHR) implementations significantly affect healthcare professionals’ work routines. Previous Epic implementations in Scandinavian hospitals have led to negative outcomes, highlighting the need for a thorough evaluation of employee experiences.</div></div><div><h3>Objective</h3><div>To qualitatively explore hospital employees’ experiences six months after Epic EHR implementation and assess implications for employee well-being and patient safety.</div></div><div><h3>Methods</h3><div>A qualitative study conducted at a Norwegian university hospital, six months post-implementation. Free-text responses from 950 employees (out of 2,115 survey respondents) were analyzed using reflexive thematic analysis within a phenomenological framework. Data were triangulated with focus group interviews and observational findings.</div></div><div><h3>Results</h3><div>Employees reported deep concerns and high emotional intensity post-implementation. Analysis revealed 13 themes, with <em>usability</em> being most prominent (n = 682 quotes). Participants described the system as cumbersome, inefficient, and counterintuitive. Other major themes included <em>work strain and own health</em> (n = 385), <em>administration of medicine and patient safety</em> (n = 201), and <em>politics and hospital management</em> (n = 184). Many employees experienced shifts in professional identity, with some expressing job abandonment intentions.</div></div><div><h3>Conclusions</h3><div>Poorly executed EHR implementations hinder professional performance, compromise patient care, and amplify emotional distress. Addressing workflow barriers and setting realistic expectations is critical for improving adoption. Future implementations must integrate employee perspectives and evidence-based strategies to ensure EHR systems enhance rather than obstruct healthcare delivery.</div></div>","PeriodicalId":54950,"journal":{"name":"International Journal of Medical Informatics","volume":"204 ","pages":"Article 106039"},"PeriodicalIF":4.1000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"“Terrible Stuff. We’ve been had“: hospital staff reactions to a new electronic health record and implications for employee well-being – A qualitative study\",\"authors\":\"Eivind Sæthre , Solveig Osborg Ose , Steinar Krokstad , Sigmund Østgård Gismervik\",\"doi\":\"10.1016/j.ijmedinf.2025.106039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Electronic Health Record (EHR) implementations significantly affect healthcare professionals’ work routines. Previous Epic implementations in Scandinavian hospitals have led to negative outcomes, highlighting the need for a thorough evaluation of employee experiences.</div></div><div><h3>Objective</h3><div>To qualitatively explore hospital employees’ experiences six months after Epic EHR implementation and assess implications for employee well-being and patient safety.</div></div><div><h3>Methods</h3><div>A qualitative study conducted at a Norwegian university hospital, six months post-implementation. Free-text responses from 950 employees (out of 2,115 survey respondents) were analyzed using reflexive thematic analysis within a phenomenological framework. Data were triangulated with focus group interviews and observational findings.</div></div><div><h3>Results</h3><div>Employees reported deep concerns and high emotional intensity post-implementation. Analysis revealed 13 themes, with <em>usability</em> being most prominent (n = 682 quotes). Participants described the system as cumbersome, inefficient, and counterintuitive. Other major themes included <em>work strain and own health</em> (n = 385), <em>administration of medicine and patient safety</em> (n = 201), and <em>politics and hospital management</em> (n = 184). Many employees experienced shifts in professional identity, with some expressing job abandonment intentions.</div></div><div><h3>Conclusions</h3><div>Poorly executed EHR implementations hinder professional performance, compromise patient care, and amplify emotional distress. Addressing workflow barriers and setting realistic expectations is critical for improving adoption. Future implementations must integrate employee perspectives and evidence-based strategies to ensure EHR systems enhance rather than obstruct healthcare delivery.</div></div>\",\"PeriodicalId\":54950,\"journal\":{\"name\":\"International Journal of Medical Informatics\",\"volume\":\"204 \",\"pages\":\"Article 106039\"},\"PeriodicalIF\":4.1000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Medical Informatics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1386505625002564\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"COMPUTER SCIENCE, INFORMATION SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Medical Informatics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1386505625002564","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"COMPUTER SCIENCE, INFORMATION SYSTEMS","Score":null,"Total":0}
“Terrible Stuff. We’ve been had“: hospital staff reactions to a new electronic health record and implications for employee well-being – A qualitative study
Background
Electronic Health Record (EHR) implementations significantly affect healthcare professionals’ work routines. Previous Epic implementations in Scandinavian hospitals have led to negative outcomes, highlighting the need for a thorough evaluation of employee experiences.
Objective
To qualitatively explore hospital employees’ experiences six months after Epic EHR implementation and assess implications for employee well-being and patient safety.
Methods
A qualitative study conducted at a Norwegian university hospital, six months post-implementation. Free-text responses from 950 employees (out of 2,115 survey respondents) were analyzed using reflexive thematic analysis within a phenomenological framework. Data were triangulated with focus group interviews and observational findings.
Results
Employees reported deep concerns and high emotional intensity post-implementation. Analysis revealed 13 themes, with usability being most prominent (n = 682 quotes). Participants described the system as cumbersome, inefficient, and counterintuitive. Other major themes included work strain and own health (n = 385), administration of medicine and patient safety (n = 201), and politics and hospital management (n = 184). Many employees experienced shifts in professional identity, with some expressing job abandonment intentions.
Conclusions
Poorly executed EHR implementations hinder professional performance, compromise patient care, and amplify emotional distress. Addressing workflow barriers and setting realistic expectations is critical for improving adoption. Future implementations must integrate employee perspectives and evidence-based strategies to ensure EHR systems enhance rather than obstruct healthcare delivery.
期刊介绍:
International Journal of Medical Informatics provides an international medium for dissemination of original results and interpretative reviews concerning the field of medical informatics. The Journal emphasizes the evaluation of systems in healthcare settings.
The scope of journal covers:
Information systems, including national or international registration systems, hospital information systems, departmental and/or physician''s office systems, document handling systems, electronic medical record systems, standardization, systems integration etc.;
Computer-aided medical decision support systems using heuristic, algorithmic and/or statistical methods as exemplified in decision theory, protocol development, artificial intelligence, etc.
Educational computer based programs pertaining to medical informatics or medicine in general;
Organizational, economic, social, clinical impact, ethical and cost-benefit aspects of IT applications in health care.