Health system executives spend a lot time performing their due diligence before they invest in new information technology, but may end up "winging it" when it comes to considering the human factors associated with implementing that technology.

Yale University researcher Christina Yuan is studying the phenomenon around those factors, particularly the role social influence plays on user attitudes about new technology. In what may be a counterintuitive finding in her latest work, Yuan found that "super users" of new electronic health records who volunteered for their positions – and who therefore felt more engaged in the process – made better trainers than those who were appointed by management, even if those appointed trainers were extremely tech-savvy.

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"This is a really important question managers have to decide, whether to let their super users volunteer for the role or to pick people who are very tech savvy and could be a whiz with the technology," Yuan told Health Data Management. "There is really great intuition for both, but this is a teaching role, so you really need people who will be good teachers.

"I had read prior studies that found in some cases the most influential people are the most competent people. That was what led me to believe that maybe if you choose very tech-savvy super users they will have the most influence because they are very adept with the computer. And other studies found the most influential people are the most approachable, that people felt more comfortable going to them."

Yuan studied the phenomenon in detail and recently published the results in the journal BMC Medical Informatics & Decision Making. Yuan and her colleagues studied two units in an academic health system during the period in which the system was implementing an Epic EHR system from October 2012 through June 2013. They observed 29 "super users" and conducted 24 in-depth interviews.

The researchers found that two factors contributed the most to successful implementation.

First, when nurse managers asked super users to volunteer for the role, individuals experienced greater role engagement because they chose to participate. The second weighted factor was the implementation climate -- managers who actively supported the organizational implementation goals and modeled proactive behavior realized more success than those who passively complied with implementation practices. An example was managers' failure in one of the studied units to anticipate the level of technical support their staff would need on the first night of the EHR implementation, with a resulting negative effect on staff morale.

Yuan also said it was important that planners take into account the great amount of stress experienced by the super users during the implementation period, especially by doing their utmost to assure proper staffing levels. “That's hard to do from the scheduling perspective, I'm sure, but these people are supposed to be devoted to this one role, and if the unit is short-staffed they suddenly become 'super user-plus.' That makes things even more stressful."

In addition to the published findings, Yuan said she also discovered that promoting hands-on learning was beneficial. The system she studied did a multi-site, multi-stage systemwide rollout, and sending super users from units that were among the first to install the technology helped their counterparts in units that adopted the platform later.

"That was really a great strategy because you learn best by doing," she said. "I think anything you can do to encourage that learning by doing and hands-on would really smooth the transition."

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