Implications of the Introduction of an Electronic Health Record: Experiences and Views of Mental Health and Addictions Services Staff

Abstract

With the growth in health informatics and reliance on electronic health records (EHR) for documenting and sharing clinical information, it is essential that information technology systems used across healthcare, support good clinical practice, meet client needs at the point of care and meet quality assurance and reporting requirements. The implementation of HCC (HealthCare Community) as the EHR for the Auckland region took place in 2009. For Counties Manukau mental health services this resulted in a transition from a paper-based to an electronic clinical documentation record. Although it has been assumed to have been successful, the perceptions and impact on stakeholders have never been formally evaluated. The study employed qualitative exploratory-descriptive research methodology in an attempt to answer the research question “What are perceptions, views and experiences of the mental health staff following the implementation of HCC and any improvements that would influence and support rollout to other service providers?” The study aims included gaining an understanding of the impact of implementation, ascertaining whether the original anticipated benefits of the implementation of HCC had been met and identifying improvements that could inform current use and further rollout of HCC to other service providers. A total of 23 participants took part in the study. Data were gathered through nine semistructured individual interviews and four focus group interviews which were audio recorded and transcribed. Transcripts were analysed using a general inductive approach and thematic analysis was used to identify, define and describe the seven major themes that emerged (Braun & Clarke, 2006). Findings revealed substantial benefits in having greater access to clinical information. Participants were concerned about the risks and challenges associated with the unexpected transformational changes to clinical thinking and practice. This included the propensity for clinicians to copy and paste information from one part of the record to another and the impact of this on navigation around the system, clinical skills and client care. In terms of rolling out HCC to other providers, participants considered strong, well-informed operational management and leadership, clear business rules, standardised practices and a focus on coaching and training would support optimal use of the system.