Evaluation of user adoption during three module deployments of region-wide electronic patient record systems

•Study of deployment of three different modules of a region-wide EPR within the same region.•Focus is increasing user adoption while deploying region-wide EPR.•Five aspects that could result in success or failure are identified.•Important knowledge about user adoption while deploying region-wide health IT is presented.•Empirical data about how individuals and the organisation are affected by the introduction of region-wide IT.

BackgroundIn Sweden there are modular region-wide EPR systems that are implemented at various health organisations in the region. The market is dominated by four IT systems that have been procured and deployed in 18 out of 21 regions.MethodsIn a 2.5-year research study, deployments of three region-wide EPR modules: a patient administration system, eReferral module and eMedication module were followed and evaluated. Health professionals, EPR maintenance organisation, IT and health care managers were observed, interviewed and responded to questionnaires.ResultsAlthough the same deployment process was used during the three deployments, large variations in the units’ adoptions were observed. The variations were due to: (1) expectation and attitude, (2) management and steering, (3) end-user involvement, (4) EPR learning, and (5) usability and the possibility of changing and improving the EPR.ConclusionsIf changes in work processes are not considered in development and deployment, the potential benefits will not be achieved. It is therefore crucial that EPR deployment is conceived as organisational development. Users must be supported not just before and during the go-live phase, but also in the post-period. A problem often encountered is that it is difficult to make late changes in a region-wide EPR, and it is an open question whether it is possible to talk about a successful deployment if the usability of the introduced system is low.