From "Local Control" to "Dependency": Transitions to Single-Vendor Integrated Electronic Health Record Systems and Their Implications for the EHR Workforce.

Background: Healthcare systems that previously used either a single legacy electronic health record (EHR) system or a "best-of-breed" combination of products from multiple vendors are increasingly adopting integrated, single-vendor EHR systems. Though healthcare leaders are beginning to recognize the dramatic collateral consequences of these transitions, their impact on the EHR workforce - internal actors most closely involved in governing and supporting the EHR - is poorly understood.

Objective: Identify perceived impacts of adopting single-vendor, integrated EHR systems on the institutional EHR workforce.

Design: In this qualitative study, we conducted semi-structured phone interviews in four healthcare systems in the USA that had adopted an integrated EHR within the previous five years.

Participants: Forty-two staff members of four geographically and organizationally diverse healthcare systems, including 22 individuals with formal informatics roles.

Approach: Transcribed interviews were coded and analyzed using qualitative content analysis methods.

Key Results: Across organizations, participants described a loss of autonomy by the EHR workforce at the individual and institutional level following the adoption of an integrated EHR. We also identified references to transformations in four key professional functions of the EHR workforce: communication, governance, optimization, and education.

Conclusions: Transitions to integrated EHR systems can have important implications for the autonomy and professional functions of the EHR workforce. These findings may help institutions embarking on similar transitions better anticipate and prepare for these changes through such practices as revising job descriptions, strengthening EHR governance structures, and reinforcing pathways to engage frontline clinicians in supporting the EHR. Findings may also help institutions structure vendor contracts in a way that anticipates and mitigates loss of autonomy.