Abstract for: Dynamics of EHR Implementations

In this paper we develop a theory to explain the dynamics of an Electronic Health Record (EHR) implementation. We base our theory on a well-established system dynamics model of improvement evolution—the model by Repenning and Sterman (RS)—with modifications that incorporate aspects of the more detailed Affordance Actualization (AA) theory. To do so we develop two simulation models: an abstract generic model for conceptualization and a more detailed operational model for policy design purposes. The conceptual model can explain general EHR implementation dynamics producing success or failure in healthcare (HC) settings. However, it is not sufficient for comprehensive policy design and analysis. The detailed operational model, on the other hand, is flexible enough to allow users to design and test their own policies. Experimentation with the operational model revealed that initial characteristics of the system are crucial to determine success or failure of an EHR implementation. We show that in the case of a failed implementation a strong connection between organizational benefits and individual benefits can make the implementation a success. Specifically, it is important to consider the reward scheme for physicians to make the implementation successful.