Evaluation of Organizational Readiness and Implementation Barriers of Electronic Health Record Systems in Hospitals: A Socio-Technical Assessment during Deployment Phase

Technical Summary: Evaluation of Organizational Readiness and Implementation Barriers of EHR Systems

Problem Statement
The global healthcare sector is undergoing a digital transformation driven by the adoption of Electronic Health Records (EHRs), which promise enhanced patient safety, clinical coordination, and operational efficiency. However, the deployment of these systems frequently encounters significant socio-technical challenges, leading to high failure rates or abandonment during the implementation phase. While traditional research often relies on linear models like the Technology Acceptance Model (TAM) or the DeLone & McLean Information Systems Success Model, these frameworks often fail to capture the complex interplay between organizational readiness, technical infrastructure, and user training in real-world clinical environments. This is particularly acute in developing and middle-income countries, where barriers such as limited financial resources, fragile infrastructure, and inadequate training frameworks exacerbate the difficulty of integrating digital systems into established workflows.

Methodology
This study employed a descriptive-analytical cross-sectional design conducted at Fatemeh Al-Zahra Hospital, a tertiary-care teaching hospital in Sirjan, Iran, during the active deployment and stabilization phase of a new centralized EHR system.

• Participants: The study sampled 185 clinical and administrative staff members, including physicians, nurses, laboratory technicians, pharmacists, and medical records personnel, who utilize the EHR system daily.
• Instrument: Data were collected via a researcher-developed, validated structured questionnaire based on socio-technical frameworks. The instrument comprised two sections: demographic characteristics and 34 items measuring seven core socio-technical constructs on a 5-point Likert scale (normalized to a 0–100 scale).
• Constructs Evaluated:
  1. User Training and Readiness
  2. Organizational Support and Readiness
  3. System Quality
  4. Technical Infrastructure and Quality
  5. User Satisfaction
  6. Technology Acceptance
  7. Implementation Success
• Analysis: Statistical analysis was performed using SPSS version 26.0. The study utilized descriptive statistics (means, standard deviations) and hierarchical ranking to identify primary barriers and facilitators. Reliability was confirmed with Cronbach's alpha coefficients ranging from 0.82 to 0.91 across the seven constructs.

Key Results
The analysis revealed a distinct discrepancy between user perception of the system's utility and the actual success of its implementation:

• High Scores: Users reported the highest levels of satisfaction (Mean = 76.34), followed by technology acceptance (74.72) and system quality (74.42). This indicates that the core software functionalities met basic expectations and that staff generally hold a positive attitude toward the system.
• Moderate Scores: Organizational support and readiness (73.63) and technical infrastructure (72.61) received moderate scores, suggesting areas for improvement in leadership commitment and hardware/network stability.
• Low Scores (Critical Barriers): The lowest scores were recorded for User Training and Readiness (67.49) and Overall Implementation Success (69.73).
• Ranking Analysis: The hierarchical ranking highlighted that high user satisfaction and acceptance do not automatically translate into optimal implementation success. The data identifies a "readiness gap" where the human-organizational components (training, preparation, and support structures) are lagging behind the technological components, acting as the primary bottleneck.

Key Contributions

• Multi-Dimensional Assessment: The study moves beyond traditional linear acceptance models to evaluate EHR implementation through a comprehensive socio-technical lens, specifically addressing the deployment phase in a tertiary hospital setting within a developing country context.
• Identification of the "Readiness Gap": By quantifying the seven constructs, the research pinpoints that the primary barrier to EHR success is not the technology itself or user willingness, but rather systemic deficits in structured training and organizational readiness.
• Empirical Evidence from Iran: The study provides specific empirical data regarding the challenges of EHR adoption in the Iranian healthcare system, a context often underrepresented in global health informatics literature.

Significance and Claims
The authors claim that the study demonstrates that EHR deployment is a multi-dimensional challenge where social and organizational factors play a more decisive role than technical components. The significance of the findings lies in the evidence that positive user attitudes and high system quality are insufficient to guarantee successful implementation if training and readiness are neglected.

The paper concludes that to maximize the value of digital health investments, healthcare administrators must shift their focus from viewing EHR implementation as a simple IT project to treating it as a socio-technical transformation. Specific recommendations include:

1. Prioritizing structured, continuous, and department-specific training programs over one-time introductory sessions.
2. Aligning system workflows with clinical reality to prevent disruption.
3. Establishing feedback loops between clinical staff and IT developers.
4. Developing national readiness assessment frameworks to evaluate infrastructure before committing to major financial investments.

The study asserts that addressing these socio-technical deficits is essential to bridge the gap between technology acceptance and actual implementation success.