(Book Review) Beyond Implementation: A Prescription for Lasting EMR Adoption – (Haugen, Woodside, 2010)

Beyond Implementation(Book Review) Beyond Implementation:  A Prescription for Lasting EMR Adoption – (Haugen,  Woodside, 2010)

I just finished reading Beyond Implementation: A Prescription for Lasting EMR Adoption by Dr. Heather Haugen and Dr. Jeffrey Woodside.  I have been fascinated with the notion of technology adoption as I have helped implement and drive adoption of software solutions in multiple companies in my career.  While the focus of this book is in Electronic Medical Record (EMR) adoption, I found the book’s core tenets and principles applicable to any new software implementation/adoption project.  Just change the acronym from EMR to Client Relationship Management (CRM) or Enterprise Resource Planning (ERP), ad infinitum.


Very early in the book, the authors stress the difference in “implementation” vs. “adoption.”  An organization can put together an Implementation Dream Team and have an amazingly successful “Go Live Launch,” only to have subsequent substandard adoption and a disgruntled end-user audience.   True adoption as described by the authors really only comes when the end user has both the knowledge and the confidence (think efficacy) to use the new solution in accordance with best practices and organizational policies as a part of their typical work routine.

It Starts at the Top

Successful adoption of any new technology solution requires engaged, inspired, and motivated leadership for several reasons.  The total cost of acquisition and ownership of any new enterprise system requires a senior level leader to make the business case and to obtain the requisite funding for the project.  But, just as importantly, this same leader must be the paragon of public communication and the corporate cheerleader for sustained use of the new technology.

Old School is Out

The authors conducted significant research of many EMR implementations and one of the red threads in their findings correlating to miserable EMR adoption was an overreliance on traditional “train the trainer” methods for end-user training.  This was exacerbated often by EMR systems not being fully ready when end-user training occurred, over-training, and “one-size-fits-all” training, which frequently occurs for these types of enterprise rollouts.  For true learning to occur, the end user must experience content, information, and knowledge in four phases:  introduction, assimilation, translation, and accumulation.

Those aforementioned phases often occur haphazardly (if at all) with traditional training practices.  End users are trained at the wrong time, in content and processes not related to their job, and way too much information.  For example, classroom training is often conducted weeks or months before the end user will actually get access to the new EMR system.  It’s going to be very difficult for the learner to recall the training when he or she gets access to the new system.

Adoption:  Just Do It

I am a huge proponent of “practicing and failing in a safe environment,” to enable true learning to occur.   It is critical for efficient role-based adoption to occur with EMR systems.  With the advent of online learning, mobile learning, and software simulations, this can be a very real and high-impact part of any EMR (or other new technology).  It is that role- and scenario-based use and practice, which not only drives and sustains knowledge, but also end-user confidence.

EMR Adoption isn’t an Event.  It is a Dynamic Evolving System

Even the best EMR projects with flawless implementations and promising organizational adoption can deteriorate if they aren’t given the proper care and feeding.  Natural questions that can arise and should be addressed include:

  • How can we effectively communicate updates and changes in workflow to users?
  • How will we educate new users?
  • How will we update quick reference guides or course materials?
  • When will metrics be collected and how will they be used?

When planning for a new system like this, make sure to include adequate post implementation resources to address new issues and requirements.

Measure, Measure, Measure

As part of the initial project planning, your team will have established success metrics for the project.  With each phase of the project through implementation and adoption, ensure you gather the right data to support the monitoring of the EMR (or other system) adoption.  This is key for overall project success, but also may be required, if any portions of the project are being paid for by granting entities, who will want to see evidence of sustained adoption.


If I had to use one word to capture the essence of this well-written book it would be: fungible.  It clearly has great alignment with EMR implementation/adoption, but its models, processes, best practices, and recommendations are applicable, I would argue, with any new technology rollout.   Please check it out.  I believe you will find it as valuable and fungible as I did.

Want to know more about Heather Haugen and The Breakaway Group?

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