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Electronic Health Record (EHR) Organizational Change: Explaining Resistance
Through Profession, Organizational Experience, and EHR Communication
Quality
Article in Health Communication · February 2017
DOI: 10.1080/10410236.2016.1278506
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Ashley K. Barrett
Baylor University
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Electronic Health Record (EHR) Organizational
Change: Explaining Resistance Through
Profession, Organizational Experience, and EHR
Communication Quality
Ashley K. Barrett
To cite this article: Ashley K. Barrett (2017): Electronic Health Record (EHR) Organizational
Change: Explaining Resistance Through Profession, Organizational Experience, and EHR
Communication Quality, Health Communication, DOI: 10.1080/10410236.2016.1278506
To link to this article: http://dx.doi.org/10.1080/10410236.2016.1278506
Published online: 03 Feb 2017.
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Electronic Health Record (EHR) Organizational Change: Explaining Resistance
Through Profession, Organizational Experience, and EHR Communication Quality
Ashley K. Barrett
Department of Communication, Baylor University
ABSTRACT
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all
healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to
comply will result in Medicare reimbursement penalties, which steadily increase with each year of
delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational
change—one of which is employee resistance. Given the penalties for violating EHR meaningful use
standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations.
This study surveyed 345 employees in one healthcare organization that recently implemented an EHR.
Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians,
nurses, and employees with more experience in their organization are the most resistant to EHR change.
The job characteristics model is used to explain these findings. Hierarchical regression analyses also
demonstrate the quality of communication surrounding EHR implementation—from both formal and
informal sources—is negatively associated with EHR resistance and positively associated with perceived
EHR implementation success and EHR’s perceived relative advantage.
The American Recovery and Reinvestment Act (ARRA)
passed by the U.S. government in 2009 is shifting the health
industry into the digital age. This legislation mandates that all
healthcare facilities adopt a certified electronic health record
(EHR) system by 2015 and achieve standards for “meaningful
use.” The criteria for achieving meaningful EHR use become
more advanced and difficult to achieve as the implementation
phases outlined in the ARRA progress.
Healthcare organizations failing to demonstrate meaningful
use by 2015 received a 1% reduction in their Medicare reim-
bursements and will receive an additional 1% reduction for
every additional year of delinquency, up to 5%. To clarify, a
non-complying private practice that earns $500,000 of annual
income lost $1,000 in reimbursement payments in 2015, will
lose $2,000 in 2016, and so on (Conn, 2013). There are several
repercussions of this governmentally mandated organizational
change that penalizes for noncompliance—one of which is
providers’ ongoing EHR resistance.
End user perceptions are key to successful EHR imple-
mentations, yet past healthcare research often emphasizes
physicians’ perceptions of EHR, while overlooking other
providers’ perceptions (McGinn et al., 2011). For example,
past research has suggested that nurses, as compared to
physicians, are more likely to acknowledge the benefits coa-
lesced with EHR technology due to the nature of nurse work
and are therefore less resistant to EHR use (Kossman,
Bonney, & Myoung, 2013). Examining the work roles and
culture of specific healthcare provider groups, and how they
are distinctly and variably impacted by EHR change, can
offer a more nuanced perspective on the foundations of
employees’ EHR resistance. Therefore, the current project
explores how professional groups—physicians, nurses,
administrators, and technicians—and different levels of
organizational experience are related to EHR resistance as a
result of corresponding workplace tasks and values. Thus,
this study offers pragmatic implications for healthcare facil-
ities currently undergoing implementation.
To assess the professional and demographical foundations of
EHR resistance, this paper uses the job characteristics model
(JCM), which emphasizes the workplace needs of specific profes-
sions. For example, JCM can be used to explain how physicians
are more resistant to EHR change because it threatens their work-
place autonomy, whereas administrators—whose job roles
demand future orientation—are less resistant to EHRs due to
their long-term financial advantage. Additionally, this study offers
a communicative perspective on EHR resistance by demonstrat-
ing how the quality of EHR change communication—from both
formal and informal sources—significantly impacts EHR resis-
tance, perceived implementation success, and EHR’s perceived
relative advantage. Therefore, this study challenges Eisenberg’s
(1984) claim that purposefully ambiguous communication can
effectively communicate change goals to organizational stake-
holders and thus elicit positive change outcomes. Considering
the limitations of previous research and the impetus for further
inquiry, this study builds a series of hypotheses that embolden
scholarly conversations on EHR resistance and offer theoretical
and practical applications for healthcare professionals tasked with
carrying out EHR changes.
CONTACT Ashley K. Barrett, PhD [e-mail] Department of Communication, Baylor University, One Bear Place #97368, Waco, TX 76798-7368, USA.
HEALTH COMMUNICATION
http://dx.doi.org/10.1080/10410236.2016.1278506
© 2017 Taylor & Francis Group, LLC

JCM: Profession, organizational experience, and
resistance
Resistance by profession
Bordia and colleagues (2004) discuss several different layers
of uncertainty that are ushered in with organizational
change. More than strategic or structural uncertainty,
job-related uncertainty—which obscures job security, job
roles, and work design—can be particularly debilitating
for employees. Introducing an advanced information tech-
nology (AIT) into an organization not only requires work-
ers to learn and cope with the material features of the
technology itself, it also compels employees to cope with
the technology’s communicative ramifications on the orga-
nization. In other words, AITs alter social and communi-
cative relationships in the workplace in both formal and
informal capacities (Dubinskas, 1988). New technologies
offer new affordances and constraints that amend profes-
sional roles through new information storage and retrieval
processes and knowledge-sharing processes in organiza-
tions (Aydin & Rice, 1992). Cognitive, interpersonal, and
organizational adjustments must follow for the full infor-
mational capacities of EHRs to be realized (Leonardi, 2007).
However, organizational behavioral and routine modifica-
tions—and the adjustments they necessitate—can be parti-
cularly taxing and complicated for employees in highly
trained and protocolled industries.
Healthcare organizations are comprised of employees who are
meticulously educated and trained within their profession. This
training and education creates distinct foundations of experience,
workplace needs, and frames of reference that correspond with
each healthcare profession (Ricketts & Fraher, 2013). Due to these
distinct methods of socialization, professions within healthcare
organizations will likely have varying perspectives on how EHR
protocols affect their work culture and various responses to EHR
change (Lewis, 2011). Providing a theoretical groundwork to this
notion, the JCM posits that employees use their individual need-
states to evaluate their job characteristics. The conformity of these
needs to observed job attributes eventuates in positive job atti-
tudes, whereas disconformities result in negative job attitudes
(Hackman & Lawler, 1971; Hackman & Oldham, 1975). For
example, because EHR systems necessitate standardization of
record keeping (Lærum, Ellingsen, & Faxvaag, 2001) and end
users often have little input on the EHR vendor chosen for their
organization (Rao, DesRoches, Donelan, Campbell, & Miralles,
2011), EHRs can threaten worker autonomy. Physicians, who
often harbor high autonomy needs, will have a negative attitude
toward an organizational change if that change entails following
more orders as compared to independently prioritizing work
tasks. Given medical practitioners are trained to espouse confi-
dence and control in the workplace (Bleakley, 2014; McCabe &
Timmins, 2003), it is not surprising that new EHR systems can
generate negative job attitudes. The enduring need-states of prac-
titioners for autonomy and certainty could cause them to interpret
their job characteristics in an adverse fashion post EHR imple-
mentation. These negative job attitudes could manifest in resis-
tance to EHR use.
As a case in point, one study on medical leadership in Canada
argues that physicians in Western populations have particularly
struggled with modern movements in medicine, such as EHR
implementation. This is due in large part to timely training
requirements and the way these new systems redesign work.
Explaining physician resistance, Chadi (2009) claims, “Many
aspects of the physician’s daily routine have changed dramati-
cally during the past generation, adding another level of com-
plexity to the management of healthcare . . . doctors are
increasingly unhappy” (p. 835). Faced with numerous problems
that challenge their need-states—like funding constraints and
demands for greater transparency—physicians feel progressively
stifled by new work stressors and sentiments that they are not as
appreciated or supported at work.
In addition to autonomy and support, workplace satisfac-
tion is also a central issue for physicians throughout EHR
implementation. According to JCM, work task identification
and perceptions of work task significance represent important
variables affecting worker attitudes (Hackman & Oldham,
1975). New EHR systems can redesign physicians’ work rou-
tines in ways that threaten these aforementioned variables.
For example, EHR system use is often rule-bound as com-
pared to autonomous, and standardized as compared to per-
sonalized (Lewis, 2011). This standardization can challenge
face-to-face patient–provider communication—which is
increasingly one of the most significant tasks in physicians’
work (see Ha & Longnecker, 2010). In turn, these interrup-
tions in patient–provider communication can decrease physi-
cians’ job satisfaction and perceived work task significance.
Physicians might then use political moves (e.g., resistance) to
hinder the EHR change process, thereby regaining control of
their work.
As a result of EHR implementation, nurses are also under-
going a workplace shift in which increasing work demands
have greatly increased nurses’ intent to leave. This self-
removal trend is expected to result in an unprecedented nur-
sing shortage that will directly affect healthcare delivery in the
coming decade (Gellasch, 2015). EHR implementation
requires nurses to tolerate a less reliable workplace as they
manage unexpected events and adjust existing organizational
rules to accommodate the new technology (Colligan, Potts,
Finn, & Sinkin, 2015). Nurses have long been depicted as
procuring a “glue function” at work, meaning they play a
central communicative role in the workplace and have a
holistic view of the patient’s medical and social needs and
other health professionals’ (inter)actions with patients
(Eggenberger, 2012, p. 504). Other scholars have described
how nurses use this glue function to enhance quality of care,
create a patient-centered working culture, and compensate for
impediments in the healthcare system (Bamford-Wade,
Tucker, Lees, & Water, 2012; McMullen, 2013). Learning a
new EHR system will at least initially throw a wrench into
nurses’ systemic performance, interfering with their workflow,
causing work interruptions, and challenging their communi-
cation with patients (McGinn et al., 2011). Thus, a new EHR
system can violate nurses’ individual need-states for efficiency
and personalization in their work.
2 A. K. BARRETT