Phased implementation of electronic health records through an office of clinical transformation

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This is a review on Banas, C. A., Erskine, A. R., Sun, S., & Retchin, S. M. (2011) article, Phased implementation of electronic health records through an office of clinical transformation [1].


The concept of health information technologies (HIT) is introduced and presented in the article as beneficial based on clinical outcomes. The article discusses HIT implementation strategies at an academic health center with an office of clinical transformation. Seven percent of the medical center's information technology budget was dedicated to the Office of Clinical Transformation, and successful conversion of 1491 physicians to electronic-based documentation was accomplished. This paper outlines the process re-design, end-user adoption, and practice transformation strategies that resulted in a 99.7% adoption rate within 6 months of the introduction of digital documentation.


With the introduction of new technologies, the medical field is being renovated like it has never before. Incentives to make electronic health records (EHR) more efficient are at an all-time high. Despite the evidence of benefits, dissemination of EHRs through the healthcare sector has been limited. The lack of engagement of clinical stakeholders likely accounts for some disappointing results.


The Virginia Commonwealth University Health System (VCUHS) has a tradition of initiatives in information technology. In 1999, VCUHS committed to update its clinical information system to a more contemporary product which promised streamlined clinical workflows and more intuitive graphical user interface. Even though VCUHS made significant investments to establish electronic-based clinical automation, clinicians complained that the new system lacked intuitiveness.

Design Objectives

The VCUHS created an Office of Clinical Transformation (OCT) in order to overcome barriers posed by traditional methods of implementing clinical applications. The OCT was established with the goal of converging clinical, educational, financial, and research activities through the application of medical informatics. Seven percent of its budget was dedicated to the OCT.

System Description

OCT members included the faculty physician informaticists, the Chief Medical Information Officer (CMIO) who served as the physician champion, nurse informaticists led by the Chief Nursing Information Officer (CNIO), and analysts. The OCT is organized into three primary domains which include: diffusion of innovation, impact assessment and interoperability. Diffusion of innovation has the purpose of facilitating adoption into the clinical environment; impact assessment evaluates the integrity of data inputted and finds whether it is capable of supporting the robust hypothesis; and interoperability seeks to provide efficient communication without any restrictions.

Status Report

There are “phases” within this process. The first phase is a six-month preparatory phase and it consists of the learning process, deployment strategies, and the production of documentation tools. Following this phase is a six-month adoptive period in which physicians are encouraged to adopt the new system and are allowed to proceed with ease by taking it slowly and comfortably. Physicians that adopted the system early found some major benefits to their time and great comfort with handling paper work. The final phase is a two-week practice transformation that had the purpose of providing aid to those that were identified as still unfamiliar with the system after the mandatory conversion, and provided them with nurses that were very much involved with the system and could explain it thoroughly and efficiently.

Discussion and Comments

The article describes as to what was most prevalent throughout the whole investigation and this is that when led by people within the clinical system of the same institution already, the transformation can be mitigated. The OCT was a vital component that helped ensure provider input and engagement. There is great value to the system that these individuals have brought forward yet this type of system might be limited to only this institution since they had tremendous help from those already within the hospital. This system, however, does extrapolate the great value of investing time into getting help from within the hospital so that the transition can be done in a much smoother fashion. I believe that the domains used within this realm of research were accurate, and accounted for things that should be significantly valued within the standards that are sought out by these transitions. Once again, this article has proven that the people involved in EMR implementation matter significantly as they become the factor or factors that could make this operation a success or a complete failure and worthless investment.


  1. Banas, C. A., Erskine, A. R., Sun, S., & Retchin, S. M. (2011) . Journal of the American Medical Informatics Association, 20, 749-757. doi: