Engaging Clinician Super Users for Successful EHR Implementation

Enlisting electronic health record (EHR) super users to provide support to employees is not enough to foster EHR implementation success—super users’ behaviors can be an important influence, researchers from Yale University found.

A comparative case study, published in BMC Medical Informatics & Decision Making, of 2 medical unites of a large, academic hospitals implementing a new EHR system found that super users who volunteered for their position fostered greater improvement in other clinicians’ information system proficiency.

In Unit 1, the nurse managers asked for volunteers for the position of super user to help with the implementation of a new EHR system. In Unit 2, nurse managers selected super users who they considered to be technologically savvy.

“We found that super users’ engagement was shaped by whether they appraised the demands as opportunities or as burdens,” authors Christina T. Yuan, MPH, MPhil, PhD Candidate, Elizabeth H. Bradley, PhD, and Ingrid Nembhard, PhD, MS, wrote.

Both volunteers and enlisted super users showed behaviors that supported implementation and undermined it. For instance, in both units, study participants named the following supportive behaviors: reporting problems with the EHR to someone in a position to fix it; employing teaching strategies that promoted “learning by doing”; and providing extra support to individuals struggling with the change.

Super users in both units also engaged in behaviors that undermined implementation efforts. These mostly stemmed from the early stage of implementation, when the super user was feeling physically and emotionally drained: losing patience with coworkers; losing track of what material was taught to whom; spreading negative opinions about the system; and creating workarounds that undermined the appropriate use of the EHR.

One difference between the units was that volunteer super users in Unit 1 were mostly described as proactively supporting the learning process while super users in Unit 2 were more reactive when it came to supporting their peers.

Overall, the researchers found greater information systems proficiency among clinicians in Unit 1, where the super users were volunteers and used more effort-intensive behaviors to foster implementation success.

“To promote super users’ engagement with the role, our results suggest that frontline managers should allow super users to volunteer for the role and create an implementation climate supportive of change,” the authors concluded.