Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence

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EBM and EHR is suggested to be an important pathway in reducing medical errors. Ambulatory electronic health records have slowly been adopted by physicians throughout the nation probably due to "organizational and physician level barriers". [1] According to McAlearney, et al (2014) the lack of success is often due not to technological problems but to organizational issues surrounding the implementation process. The purpose of the implementation of EBM and EHR in the ambulatory setting is to integrate information technology and healthcare management and therefore improve healthcare outcomes. The goal of this article is to demonstrate how evidence based medicine (EBM) was used within the context of ambulatory EHR. [1]


The assessment of this study utilizes the following specific key points on research design focused on obtaining the physician's and organization's perspective.

  • Informant Interviews: standard questionnaires to ensure consistency.
  • Focus groups: includes discussion questions with emphasis on their perceptions towards the implementation of EHR systems.
  • Study sites: six study sites were selected according to their participation and success in the implementation of EHR system.
  • Study participants: 37 physicians and 45 organizational and clinical informants were interviewed.


The results were based on a proposed plan to implement a structure model named Plan-Do-Study-Act (PDSA). According to the author this is a quality improvement model that will facilitate the success of Evidence Based Health Services Management (EBHSM) implementation.

  • Plan: includes implementation and planning.
  • Do: Go live support and ongoing IT support for EHR use.
  • Study: involves the reflection of the implementation process and application of what was learned.
  • Act: provision of constructive feedback from the process.

In addition, there were three strategies that also contributed to the successful implementation of EBHSM described in this article.

  • Applying the evidence from iterative reviews and implementation facilitators.
  • Focusing on the workflow to improve communication and participation of the staff and providers.
  • Incorporation of critical management factors to facilitate implementation considering commitment, coordination and reorganization of management.


The authors concluded that by applying the PDSA quality improvement model will help in the ambulatory electronic health record system implementation. They propose this model will guide and direct the success of the organization, integration and implementation the EHR and allow EBM to be a qualitative support in medical practice. According to McAlearney, et al (2014) [1] "the PDSA model can serve as an important vehicle to introduce and incorporate evidence based practice.


Evidence-based medicine integrated into the EHR is an essential tool for improving health outcomes and reducing medical errors. Some of the barriers for the adoption and implementation of EBM and EHR are lack of leadership and management skills, lack of trained staff among others. This article describes a simple and interesting strategy to accomplish this in the ambulatory setting.

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  1. 1.0 1.1 1.2 Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence, http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pubmed/24862893, McAlearney, A. S., Hefner, J. L., Sieck, C., Rizer, M., & Huerta, T. R. (2014). 83(7), 484-494.