{"id":2880,"date":"2013-06-05T05:09:10","date_gmt":"2013-06-05T05:09:10","guid":{"rendered":"http:\/\/cjni.net\/journal\/?p=2880"},"modified":"2016-09-26T00:35:06","modified_gmt":"2016-09-26T00:35:06","slug":"using-kotters-change-management-theory-and-innovation-diffusion-theory-in-implementing-an-electronic-medical-record","status":"publish","type":"post","link":"https:\/\/cjni.net\/journal\/?p=2880","title":{"rendered":"Using Kotter\u2019s Change Management Theory and Innovation Diffusion Theory In Implementing an Electronic Medical Record"},"content":{"rendered":"

by Melanie Neumeier, RN<\/em><\/p>\n

Masters of Nursing Student,<\/em><\/p>\n

Memorial University of Newfoundland and Labrador<\/em><\/p>\n

Abstract<\/b><\/h1>\n

\"Neumeier\"The high incidence of preventable medical errors in health care is a key factor that has led to pressure on health care organizations to implement electronic medical records (EMRs) as a means to mitigate the issues antecedent to these adverse outcomes.\u00a0 However, despite the potential benefits of implementing an EMR, the adoption of this technology has been slow.\u00a0 There are many potential barriers to the implementation of an EMR with the most salient being poor change management.\u00a0 There are many change management theories available and two that have been used to successfully implement technological innovations in health care are Kotter\u2019s Change Management Theory and Rogers\u2019 Innovation Diffusion theory.\u00a0 This article presents a theoretical discussion of how a combination of these two theories could be applied in practice to successfully implement an EMR.<\/p>\n

Key Words<\/b><\/h2>\n

Electronic medical record, change management, innovation diffusion, Kotter\u2019s Change Management Theory, Rogers\u2019 Innovation Diffusion theory<\/p>\n

Introduction<\/h1>\n

The trend in the United States following the Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System<\/i> has been to move toward the adoption of an electronic health record (EHR) as a means to transform health care and improve patient safety (Pomerleau, 2008).\u00a0 The goal of an electronic health record that connects care providers to patient information nationwide has permeated the Canadian health care system as well, but before a national EHR can be realized, health regions across the country need to implement an electronic medical record (EMR).\u00a0 The electronic medical record (EMR) allows for efficient access to patient information and can include functions such as computerized prescriber order entry (CPOE) and electronic medication administration record (eMAR) (Holtz & Krein, 2011).\u00a0 Using an EMR with CPOE improves access to more complete patient information (Holtz & Krein, 2011), enhances medication safety, \u00a0decreases prescribing errors (Horning, 2011), and eliminates the need for redundant data entry and the potential for error that causes (McLane, 2005).\u00a0 Yet despite these benefits many health regions are slow to adopt this technology (Wolf, 2006).\u00a0 One of the reasons for this slow adoption may be that reports show up to 50 per cent of attempts to implement health information technology (HIT) initiatives fail (McLane, 2005). \u00a0Barriers to the successful implementation of an EMR identified in the literature include: high costs, lack of standardization, concerns about privacy, and an unwillingness of staff to accept and use the new system (Hillestead et al., 2005; McLane, 2005).<\/p>\n

Effective change management is integral to the successful implementation of an EMR (McCarthy & Eastman, 2010).\u00a0 Change management is about engaging and preparing people.\u00a0 It is about behavior change, maximizing abilities, and achieving results. \u00a0It is about identifying and anticipating barriers and creating strategic solutions.\u00a0 It is the human side of implementation, and it is an essential practice in order to be successful in \u201cthe new world of EMRs\u201d (p. 2).\u00a0 The purpose of this paper is to demonstrate how using Kotter\u2019s Change Management Theory and Rogers\u2019 Innovation Diffusion Theory can help identify and address barriers to change that could be encountered when implementing an EMR.<\/p>\n

Implementing an EMR<\/b><\/h1>\n

The IOM report To Err is Human: Building a Safer Health System<\/i> (2000) details shocking statistics that at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year in the United States as a result of preventable medical errors.\u00a0 Estimates from the Canadian Institute for Health Information (CIHI) suggested that one in ten adult Canadians taking medications would receive the wrong medication or dose (CIHI, 2007).\u00a0 These errors have been linked to system issues that lead people to make mistakes or fail to prevent them, versus poor care from individual providers (IOM, 2000).\u00a0 System issues that have been implicated include: difficulty in obtaining complete and accurate patient medication lists, multiple care providers in multiple locations with access to incomplete information, transcription errors, illegible writing, delay in receiving information, lack of clinical decision support tools, and lack of automated medication alert systems (CIHI, 2007; IOM, 2000; McLane, 2005; Sassen, 2009).\u00a0 As systems issues have been identified as contributing factors mistakes can best be prevented through systems interventions that make it \u201charder for people to do something wrong and easier for them to do it right\u201d (IOM, 2000, p.2). \u00a0One of the primary ways to improve patient safety is to reduce the risk of adverse drug events, and one strategy for reducing that risk is to implement an EMR (CIHI, 2007).<\/p>\n

\u00a0What is an EMR?<\/b><\/h2>\n

\u201cAn EMR is one or more computerized clinical information systems that collects, stores, and displays patient information\u201d (McLane, 2005, p.85).\u00a0 An EMR is designed to replace the traditional paper medical record, and at its most basic level, provides a legible, organized method of recording and retrieving patient information.\u00a0 An EMR allows for \u201cefficient retrieval and access to patient data, including notes, laboratory results, and prescription records\u201d (Holtz & Krein, 2011, p. 248).\u00a0 However, an EMR is more than just an efficient electronic filing system for patient records.\u00a0 An EMR can include patient safety and provider support features such as computerized clinical decision support (CDS), computerized provider order entry (CPOE), electronic medication administration record (eMAR), and electronic medication alerts, just to name a few.\u00a0 These embedded safety and clinical support tools have been shown to decrease the number of prescribing and medication administration errors, improve access to information and decision making, and decrease costs (CIHI, 2007; Holtz & Krein, 2011; IOM, 2000).\u00a0 However, despite the evidence to suggest that implementing an EMR may reduce system inefficiencies that are contributing to adverse events, the adoption of this technology has been slow, and many attempts to implement change have been unsuccessful (McLane, 2005; Wolf, 2006).<\/p>\n

Barriers to Implementation<\/b><\/h2>\n

Barriers to successful implementation of EMRs identified in the literature include: high costs, lack of standardization, concerns about privacy, and an unwillingness of staff to accept and use the new system (Hillestead et al., 2005; McLane, 2005). <\/b><\/p>\n

However, considering that attempts to implement EMRs continue to fail despite the commitment of serious financial resources (McLane, 2005), I would suggest that the most significant barrier to implementation is a resistance to change.\u00a0 An EMR is not simply a tool to enhance efficiency through automation, but is in fact a transformational tool that \u201crefashions how work is done and how people relate to each other\u201d (McLane, 2005, p. 87).\u00a0 Implementing an EMR involves significant change, and if that change was not sought by staff, significant resistance may be the response.\u00a0 Staff acceptance of and willingness to use an innovation are major determinants of that innovation\u2019s success and considering that nurses are a primary stakeholder in healthcare, it is important to understand their adoption tendencies in order to develop a successful implementation plan (Holtz & Krein, 2011).<\/p>\n

In her review of the current literature on EMR implementation Sassen (2009) examined nurses\u2019 feelings about the EMR and reasons for adopting or rejecting it.\u00a0 She found that the most important factor influencing the attitude a nurse ultimately adopts towards an EMR are the change management techniques used.\u00a0 Nurses emphasized the need to be involved in the decision making process from the beginning as part of project teams and usability testing.\u00a0 When nurses were not included in shared decision making their suspicions and myths regarding EMRs were not dispelled, and the EMR did not adequately support nurses\u2019 work.\u00a0 Neglecting to manage the human side of technology implementation led to serious challenges and failure for the EMR to be adopted.<\/p>\n

As a change management strategy prior to the roll out of an EMR, McLane (2005) surveyed a sample of staff to gain an understanding of their experience with and opinions about computers and their expectations for the EMR.\u00a0 Concerns about patient confidentiality and nursing workload were raised in the surveys.\u00a0 Survey data was used to guide staff education about expected benefits of the EMR and when those benefits would be seen, as well as patient safety features of the EMR including confidentiality protection.\u00a0 The survey data also guided the development and design of the nursing documentation feature.\u00a0 Assessing and recognizing the attitudes and expectations of staff prior to the implementation of the EMR allowed the planning team to create a system that met the needs of its users and resulted in a successful launch of their EMR.<\/p>\n

Holtz and Krein (2011) used the unified theory of acceptance and use of technology (UTAUT) model to understand nurses\u2019 perceptions of a newly implemented EMR.\u00a0 The UTAUT model considers performance expectancy, effort expectancy, social influence, and facilitating conditions as key predictors of a person\u2019s intention to use technology and actual use behavior.\u00a0 Results of the study showed performance expectancy or the degree to which an individual believes an innovation will help them perform their job, and social influence or the degree to which an individual feels social pressures to use an innovation, were significant factors in EMR adoption.\u00a0 Social influence was found to be the most significant factor with nurses having the strongest influence on the attitudes and perceptions of their nursing coworkers.\u00a0 Nurses in this report were more concerned about the impressions of other nurses than the improved productivity provided by the EMR.<\/p>\n

This brief review of the literature highlights the importance of understanding the human side of technology implementation.\u00a0 Discrete barriers and facilitators to successful EMR implementation varied, but the need to address the human factors in change was clear.\u00a0 McCarthy and Eastman (2010) state \u201cIf the goal of your EMR implementation is to achieve sustainable results, growth, or organizational transformation, then a substantial investment in people must be central to your overall implementation strategy\u201d (p.viii).\u00a0 I believe that this investment in people can be facilitated through the thoughtful application of change management theory.<\/p>\n

Theoretical Framework<\/b><\/h1>\n

Initiating a change is a complicated process, and following a theoretical framework can provide a basis for making informed decisions that allows for better control over the outcomes of action (McEwen & Wills, 2007).\u00a0 Two theories on change and innovation that have been used successfully to facilitate the adoption of technology in health care organizations are Rogers\u2019 Innovation Diffusion Theory and Kotter\u2019s Change Management Model (Campbell, 2008; Wolf, 2006).\u00a0 Both of these models provide steps and guidelines for engaging individuals and organizations to support both willingness and ability, thus helping to improve the likelihood the EMR would be adopted.<\/p>\n

Kotter\u2019s Change Management Theory<\/b><\/h2>\n

There are many different change management models, but one that has been used successfully in health care (Clark, 2010), and specifically to address the adoption of technological innovations (Campbell, 2008), is John Kotter\u2019s eight-stage process for transformational change (Kotter, 1996).\u00a0 This dynamic model is comprised of eight stages that can be organized into three phases.\u00a0 The first phase is \u201ccreating a climate for change\u201d and includes establishing a sense of urgency, creating a guiding coalition, and developing a vision and strategy.\u00a0 The second phase is \u201cengaging and enabling the organization\u201d and includes communicating the vision, empowering action, and creating short-term wins.\u00a0 The final phase is \u201cimplementing and sustaining the change\u201d and includes consolidating gains and producing more change, and anchoring new approaches in the culture.<\/p>\n

Creating a climate for change <\/b><\/h3>\n

The first stage is establishing a sense of urgency.\u00a0 The biggest mistake in attempting change is to allow complacency (Kotter, 1996).\u00a0 This is a critical step because without a sense of urgency people will cling to the status quo and resist change.\u00a0 Creating urgency involves helping people see and feel first hand why a change needs to occur (Campbell, 2008).<\/p>\n

The second stage is creating a guiding coalition.\u00a0 The guiding team members need to have the knowledge, credibility, influence, and skills required to mobilize change (Kotter, 1996).\u00a0 The third stage is developing a vision and strategy.\u00a0 In this stage you need to create a clear and defining vision that is shared by all stakeholders.\u00a0 The result should be a compelling statement that clearly articulates what you are trying to achieve that can be explained in five minutes or less (Kotter, 1996).\u00a0 The vision needs to include a collective sense of what a desirable future looks like, in clear and measurable terms that all stakeholders can stand behind (Clark, 2010).<\/p>\n

Engaging and enabling the organization<\/b><\/h3>\n

The first stage in this phase is communicating the vision.\u00a0 Once the vision has been created and agreed upon by members from all stakeholder groups, it is imperative that it be communicated frequently and convincingly to all groups.\u00a0 This involves communicating the vision in words and actions by leading through example.\u00a0 Members from all groups need to be hearing the same message from everyone in order to gain buy-in and guide them from awareness of the change to a state where they feel empowered to advocate for the change (Campbell, 2008).\u00a0 This involves engaging in continuous dialogue with stakeholders to build commitment and trust.<\/p>\n

The next two stages in this phase are enabling action and creating short-term wins.\u00a0 At this stage all parties need to work together to remove obstacles and empower all members to participate.\u00a0 It may involve providing incentives for embracing change, and feedback on how they can use the changes for their benefit (Campbell, 2008).\u00a0 Changing the culture of a workplace takes time, and as time goes on urgency drops and complacency rises (Kotter, 1996).\u00a0 Creating short-term wins can help keep the momentum going. Wins should be celebrated in a highly visible way that is connected to the vision and then that momentum can be used to set new achievable goals (Clark, 2010).\u00a0 After each win it is important to analyze what went right and what needs improvement.<\/p>\n

Implementing and sustaining the change<\/b><\/h3>\n

\u00a0 <\/b>The seventh and eighth stages are consolidating gains to produce more change and anchoring new approaches in the organizational culture.\u00a0 The warning in these stages is not to declare victory prematurely.\u00a0 Declaring that the change has been successfully implemented means that people lose all urgency and if the changes have not been firmly anchored into the culture, people will slip back into the \u201cold\u201d way of doing things (Kotter, 1996).\u00a0 In this phase there needs to be a continued focus on the desired vision and the strategic steps required to achieve it until the change becomes a permanent part of the organization\u2019s culture and is reflected in the shared norms and values (Clark, 2010).<\/p>\n

Rogers\u2019 Innovation Diffusion Theory<\/b><\/h2>\n

Rogers (1983) defined innovation as \u201can idea, practice, or object that is perceived as new\u201d (p. 11), and diffusion as \u201cthe process by which an innovation is communicated through certain channels over time among the members of a social system\u201d (p.10).\u00a0 As a new idea or innovation is shared throughout an organization there will be individuals within that organization that adopt the innovation sooner than others.\u00a0 According to Rogers (1983) there are five classifications of individuals when it comes to the adoption of an innovation.\u00a0 The very first people to adopt the innovation are known as the innovators, followed by the early adopters, early majority, late majority, and followed lastly if at all by the laggards.\u00a0 Innovators are keen to change and try new things, and represent a very small percentage of the population.\u00a0 Early adopters are the opinion leaders in an organization that other people will observe to determine if an innovation is worthwhile.\u00a0 The people in the early majority group take more time to consider if they will try an innovation than the early adopters, while those in the late majority group tend to adopt an innovation only after the majority of individuals in the organization have already done so.\u00a0 The laggards are the last group to adopt an innovation after everyone else has accepted the change, and some individuals in this group may never adopt the innovation.<\/p>\n

Rogers (1983) identified five main stages in the innovation diffusion process: knowledge; persuasion; decision; implementation; and confirmation.\u00a0 Rogers (1983) stated that \u201cknowledge occurs when an individual is exposed to the innovation\u2019s existence and gains some understanding of how it functions\u201d (p.20).\u00a0 At the knowledge stage an individual wants to know what the innovation is, and how and why it works.\u00a0 \u201cPersuasion occurs when an individual forms a favorable or unfavorable attitude toward the innovation\u201d (Rogers, 1983, p.20).\u00a0 In this stage people want to decrease the uncertainty about the outcome of using an innovation.\u00a0 People want to know the advantages and disadvantages of an innovation and how its use would ultimately affect them.<\/p>\n

The decision stage is the stage where a choice is made whether or not to implement an innovation (Rogers, 1983).\u00a0 Factors that may hinder or facilitate the decision to adopt an innovation are related to the perceived attributes of the innovation which include its relative advantage, compatibility, complexity, trialability, and observability.\u00a0 These perceived attributes of an innovation are what make it more or less appealing (Ting-Ting Lee, 2004).\u00a0 The relative advantage is the degree to which an innovation is perceived as better than the current practice.\u00a0 It is the perception of how beneficial the change will be.\u00a0 Compatibility is the degree of fit between the proposed change and the individuals or organization that is undergoing the change (Horner, et al., 2004).\u00a0 This relates to how consistent the innovation is with individual and organizational \u201cvalues, beliefs, past experiences, and needs\u201d (Ting-Ting Lee, 2004, p. 232).\u00a0 The complexity is the degree to which an innovation is perceived as difficult to understand or use.\u00a0 Trialability refers to the availability of opportunities to test the innovation before wide-scale adoption, and observability refers to the extent that the results are visible to others.\u00a0 Innovations with a high degree of observability tend to be adopted faster than those where the results are not highly visible (Rogers, 1983).<\/p>\n

Once the decision is made to accept an innovation, the implementation stage begins.\u00a0 The implementation stage is the actual implementation of the innovation, and the confirmation stage involves evaluating the worth of the innovation over time.\u00a0 In the following section I discuss how using Rogers\u2019 Innovation Diffusion Theory in conjunction with Kotter\u2019s Change Management Theory can guide the successful adoption and implementation of an EMR.<\/p>\n

Discussion<\/b><\/h1>\n

I believe that the marriage of Rogers\u2019 Innovation Diffusion Theory and Kotter\u2019s Change Management Theory provides a unique way to understand and approach the implementation of technological innovations.\u00a0 I have combined the models and organized them into three distinct phases: planning change, implementing change, and cementing change.<\/p>\n

Planning Change<\/b><\/h2>\n

This phase incorporates the change strategies from Kotter\u2019s first four stages (establishing a sense of urgency, creating a guiding coalition, developing a vision and strategy, and communicating the vision) along with the knowledge, persuasion, and decision phases of the Innovation Diffusion Theory.\u00a0 Taking the time to understand your end users is essential in this phase.\u00a0 Using surveys, focus groups, or interviews to gain an understanding of the needs, wants, expectations, and attitudes of all user groups is a great start.\u00a0 In this phase group leaders should share knowledge about what an EMR is and is not, and deal with any misconceptions or unrealistic expectations.\u00a0 Developing a sense of urgency can be a part of the awareness campaign and is an integral component of persuasion.\u00a0 People need more than to understand that there is a need for change, they need to feel it (Kotter, 1996).\u00a0 This urgency can be created by showing videos that share the personal repercussions of preventable medical errors, or the success stories of other hospitals that have successfully implemented an EMR (Campbell, 2008).\u00a0 Data from the organizational assessment should be used to generate other ideas for creating urgency that would be applicable for each institution and the unique motivating needs of its members.<\/p>\n

Creating a guiding coalition involves selecting the right people, and these people should include early adopters from each end user group.\u00a0 These early adopters are opinion leaders who can help continue to drive the sense of urgency and motivate the early majority to buy in to the project.\u00a0 Early adopters can be recruited as system super-users or EMR peer experts.\u00a0 This can aid in persuasion as Holtz and Krein (2011) discovered that nurses\u2019 social influence on each other had the most significance in their decision to adopt the EMR.<\/p>\n

Developing a vision and a strategy needs to be completed with representatives from all stakeholder groups and should include the data gleaned from the pre-implementation assessment.\u00a0 The vision statement should be service-oriented in order to create emotional motivation, and not specifically related to efficiency or cost containment (Campbell, 2008).\u00a0 Once this vision is decided it should be communicated frequently, in multiple media forms, and to all groups that will be impacted by the EMR implementation.<\/p>\n

The perceived attributes of the EMR, and how those advantages can be showcased should also be considered at this stage.\u00a0 Based on data from the initial assessment and information gained from continual \u2018pulse checks\u2019 throughout the process, adjustments to the design features of the EMR and communications about the EMR should be made to address the perceived attributes of the EMR.\u00a0 End users need to be able to test out the EMR to see if it meets their needs and will in fact improve their work.\u00a0 Training needs to occur to decrease the perceived complexity of the EMR and increase its relative advantage.\u00a0 The creation of the guiding vision needs to be done with compatibility factors in mind, and the positive impact the EMR is expected to have on the organization should be highly publicized.<\/p>\n

Implementing Change<\/b><\/h2>\n

This stage involves the actual roll out of the planned change.\u00a0 This involves anticipating barriers and removing obstacles, empowering action, providing incentives, and creating and celebrating short-term wins.\u00a0 This might mean that when you go live with the EMR that extra staff work each shift including super-users to reduce stress and deal with any operational difficulties.\u00a0 Units that are having difficulty with implementation may benefit from having users from successful units come and share their tips and strategies (Campbell, 2008).\u00a0 Short-term wins can be at the individual, unit, or organizational level.\u00a0 For each nurse who was afraid to use the computer and now completes her\/his computer charting effortlessly, and for each regular staff who takes on a leadership role as a super-user there should be public recognition.\u00a0 Each unit that reaches 100% implementation and every decrease in medication errors or increase in patient satisfaction related to the EMR should be celebrated.\u00a0 The organization should celebrate each team win and market their successes to other health regions and the public.\u00a0 As each win is celebrated the focus needs to return to the vision and the steps required reach that vision.<\/p>\n

Cementing Change<\/b><\/h2>\n

The final stage is cementing change and includes the confirmation of the change through consolidating gains to create more change, and anchoring that change within the organizational culture.\u00a0 The fatal flaw in this stage would be to abandon the change process as soon as the EMR was officially up and running.\u00a0 Changing culture takes time, and old habits quickly take hold once the urgency is lost.\u00a0 Dedicated teams can be created to deal with unforeseen system or user problems as they arise, and information about what else is achievable or what other health care organizations are doing can be shared to help sustain the change (Campbell, 2008).\u00a0 Change can only be cemented once it becomes part of the organizational culture, or in other words, when it simply becomes \u201cthe way we do things around here\u201d and this can only be accomplished once the change has been shown to be successful over time (p.33).\u00a0 So keep the dialogue going, keep identifying and training new super-users, and keep the vision at the forefront of the action.<\/p>\n

Conclusion<\/b><\/h1>\n

In response to the devastating effects of preventable medical errors, there has been increasing pressure for health care organizations to adopt EMRs.\u00a0 EMRs allow for efficient access to complete patient information and have been shown to mitigate some of the systems causes of adverse events.\u00a0 However, despite the potential benefits of EMRs and the pressure to implement them, adoption of this technology continues to be slow.\u00a0 In this paper I identified potential barriers to the implementation of an EMR, with a specific focus on change management issues.\u00a0 Change is a challenging process, and successful change is not accidental.\u00a0 The integration of a theoretical framework that combines Kotter\u2019s Change Management Theory and Rogers\u2019 Innovation Diffusion Theory can provide the necessary structure to successfully plan, implement, and cement the adoption of an EMR.<\/p>\n

References<\/h1>\n

Campbell, R. J. (2008). Change management in health care. Health Care Manager, 27<\/i>(1), 23-39.<\/p>\n

CIHI (2007).\u00a0 Patient Safety in Canada: An Update.\u00a0 Retrieved from: https:\/\/secure.cihi.ca\/free_products\/Patient_Safety_AIB_EN_070814.pdf<\/p>\n

Clark, C. (2010). From incivility to civility: Transforming the culture. Reflections on Nursing Leadership, 36<\/i>(3).<\/p>\n

Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs, 24<\/i>(5), 1103-1117.<\/p>\n

Holtz, B., & Krein, S. (2011). Understanding nurse perceptions of a newly implemented electronic medical record system. Journal of Technology in Human Services, 29<\/i>(4), 247-262. doi: 10.1080\/15228835.2011.639931<\/p>\n

Horner, S.D., Abel, E., Taylor, K., & Sands, D.\u00a0 (2004). Using theory to guide the diffusion of genetics content in nursing curricula.\u00a0 Nurse Outlook, 52<\/i>, 80-84.\u00a0 doi: 10.1016\/j.outlook.2003.08.008<\/p>\n

Horning, R. (2011). Implementing an electronic medical record with computerized prescriber order entry at a critical access hospital. American Journal of Health-System Pharmacy, 68<\/i>(23), 2288-2292. doi:10.2146\/ajhp110249<\/p>\n

IOM (2000).\u00a0 To Err is Human 1999 report brief. <\/a><\/p>\n

Kotter, J.P. (1996). Leading Change. Boston, MA: Harvard Business School Press.<\/p>\n

McCarthy, C., & Eastman, D. (2010).\u00a0 Change Management Strategies for an Effective EMR Implementation.\u00a0 HIMSS, Chicago, IL.<\/p>\n

McLane, S. (2005). Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. CIN: Computers, Informatics, Nursing, 23<\/i>(2), 85-92.<\/p>\n

McEwen, M., & Wills, E.M. (2007).\u00a0 Theoretical Basis for Nursing<\/i> 2nd<\/sup> Edition. New York, NY: Lippincott Williams & Wilkins.<\/p>\n

Pomerleau, M. (2008). Electronic health record: Are you ready for the next step? Nursing for Women’s Health, 12<\/i>(2), 151-156.<\/p>\n

Rogers, E. (1983).\u00a0 Diffusion of Innovations<\/i>. New York, NY: Free Press.<\/p>\n

Sassen EJ. (2009). Love, hate, or indifference: How nurses really feel about the electronic health record system. Computers, Informatics, Nursing, 27<\/i>(5), 281-287.<\/p>\n

Ting-Ting Lee (2004). Nurses\u2019 adoption of technology: Application of Rogers\u2019 Innovation-Diffusion Model. Applied Nursing Research<\/i>, 17(4), 231-238. doi: 10.1016\/S0897-1897(04)00071-0<\/p>\n

Wolf DM. (2006). Community hospital successfully implements eRecord and CPOE. Computers, Informatics, Nursing, 24<\/i>(6), 307-316.<\/p>\n

Author Biography<\/b><\/h1>\n

Melanie Neumeier, RN, is an MN student at Memorial University of Newfoundland and Labrador and is an adjunct professor with the University of Regina and the Saskatchewan Institute of Applied Science and Technology (SIAST) in Saskatoon, SK.\u00a0 She currently teaches clinical courses and health assessment and has a nursing background in cardiac surgery and home enteral nutrition.<\/p>\n

 <\/p>\n

\"Return<\/a>

Return to Index<\/p><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

by Melanie.Neumeier<\/p>\n

Vol 8 No 1 & 2
\nWinter\/Spring 2013<\/p>\n","protected":false},"author":1,"featured_media":2934,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[736],"tags":[36,338,63,39,17,16,790,10,62,55,791,792,65,751,19,793,132,48],"_links":{"self":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2880"}],"collection":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2880"}],"version-history":[{"count":36,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2880\/revisions"}],"predecessor-version":[{"id":4899,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2880\/revisions\/4899"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=\/wp\/v2\/media\/2934"}],"wp:attachment":[{"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2880"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2880"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cjni.net\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2880"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}