Background: With the still larger scale of electronic health records (EHRs), their implementation has become increasingly complex. In this study, we focus on one large-scale EHR - Epic.
Purpose: We analyze the Epic implementations in Denmark and Finland to understand how healthcare professionals experience this large-scale EHR.
Method: The study is based on documentary analysis. The analyzed documents include user surveys, assessment reports, material from project partners, and research papers.
Results: The Danish and Finnish Epic implementations are still troubled five and three years, respectively, after the first go-live. In Denmark, the business case and implementation process have been sharply criticized. The correction of usability problems and unstable system integrations have been slow, the time required to perform common clinical tasks has increased, and 32% of the users remain dissatisfied or very dissatisfied with the system. In Finland, the physicians and nurses experience improved technical performance but inferior usability and reduced work support compared to the EHR they used before Epic; only 4.7% (physicians) and 7.3% (nurses) agree that patient information is easy to access, and only 9.3% (physicians) and 26.2% (nurses) agree that Epic helps improve the quality of care.
Conclusion: The post-implementation experiences from the two implementations contradict pre-implementation expectations. Specifically, the consequences of using Epic have become salient only after go-live. As a result, the implementing organizations and their users have predominantly found themselves in a reactive mode of fending off problems rather than a proactive mode of realizing benefits.
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