Exploratory Case Study of Barriers and Facilitators Associated With the Pilot Implementation of a New Electronic Healthcare Record in the Military

Abstract

Introduction: The Military Health System (MHS) overhauled its previous Electronic Health Records (EHRs) system. The MHS is in need of modernizing its healthcare system to improve patient safety and coordination of care between the MHS and Veterans Affairs. In 2015, the DoD awarded Cerner, Leidos, and Accenture a $4.3 billion EHR contract for a commercialized off-the-shelf system model to be used by more than 146,000 end users. This exploratory case study looked to access socio-technical barriers and facilitators to EHR implementation specifically in the military. Materials and Methods: A document review served as the data source: implementation plans, evaluation reports, congressional reports, news articles, and relevant peer-reviewed literature. A series of a priori codes were developed, and emergent codes arose out of the thematic analysis process. Results: There were several constructs that emerged from the analysis, placing emphasis on the uniqueness of EHR implementation in the MHS. The constructs of people, communication, and hardware and technical factors were strongly tied to EHR implementation. Additionally, medical readiness was identified in the analysis as a unique factor specific to the EHR implementation in the MHS. Conclusion: This research identified three strategic recommendations for the MHS to consider: hire clinical informaticists, parallel EHR implementation, and enhance EHR training. This research also informed a Socio-Technical Leadership Framework for EHR Implementation to guide MHS leaders during health information technology implementation. Although significant health information technology changes may occur only once every few years, having issues during implementation impacts mission success, overall threatening the vital role that the MHS provides to national defense.