Technology Readiness through Collaborative Reflection: A Qualitative Case Study of an Under-Resourced Nurse-Managed Clinic Charlotte Tang University of Michigan-Flint tcharlot@umflint.edu Yunan Chen University of California, Irvine yunanc@ics.uci.edu Abstract This paper reports how a nurse-managed primary care clinic (NMPCC) prepared for the implementation of an Electronic Health Record (EHR) system with limited resources. EHR adoption is a complex task that requires not only implementing a system but also an integration of the system into the existing sociotechnical environments. In this study, we identified three stages of the process improvement meetings conducted at the clinic: (1) understanding routines, roles, and practices, (2) identifying problems and deficiencies, and (3) iterating interventions by optimizing resources through reconfiguring artifacts and work practices. Importantly, we found the staff jointly reflecting on one another’s experiences and practices by making sense of the collaborative work. We regarded this sense-making process as collaborative reflection, and argued that it enhanced technology readiness of the NMPCC through creating a more technology-compatible and collaborative sociotechnical environment for the impending EHR implementation. 1. Introduction The implementation of health information technology (HIT) in clinical settings, e.g. Electronic Health Record (EHR) systems, is challenging and often associated with a variety of adoption barriers, such as the design of systems that do not support frontline clinical processes [1][2] and resistance from end-users [3][4]. HIT adoption requires not only system deployment, but also a seamless integration of the system into existing patient care practices that include workflow, team coordination, as well as established norms, culture, and policies in local practices [5]. Even well-planned EHR deployment can lead to unintended consequences such as decreased efficiency and increased threat to patient safety [6], frequent and unplanned interruptions in the workflow, development of workarounds that often worked against the system design [7][2], perpetual resistance, and sometimes failure in adoption [3]. To avoid these issues, many health organizations spend tremendous efforts and resources to prepare for their imminent EHR adoption. Most prior studies investigated the EHR adoption process after its deployment; they mainly focused on large health organizations, e.g. [1][7][8][9]. These studies have identified various unintended consequences, often resulting from the gap between the current sociotechnical context and the demand of new technologies. Sociotechnical issues are considered crucial for successful HIT adoption, and they consist of a variety of factors such as organizational culture, team morale, work processes, and IT policies [10][11]. To narrow the gap, many health organizations are actively engaging in various pre-implementation strategic planning such as user training and policy adaptation as ways to prepare for their upcoming implementation. However these efforts are often expensive and require substantial resources. Very few studies have examined the EHR adoption in small and under-resourced environments prior to the introduction of the system. Dennehy et al. investigated HIT deployment in several small nurse-managed health centers, but they only focused on the effectiveness of their partnership model in supporting organization-level readiness for EHR systems [3]. In reality, under- resourced healthcare organizations such as nurse- managed primary care clinics (NMPCCs) often face severe financial challenges that can impact their survival in the competitive healthcare climate [12]. Yet, NMPCCs play a crucial and indispensible role in the U.S. healthcare system [12], where nurse practitioners provide holistic patient care services to underserved and vulnerable populations. Studying how NMPCCs use limited resources to prepare for the adoption of a system with a high price tag such as an EHR system would make an interesting case for understanding how under- resourced organizations struggle to provide services with cutting-edge technologies. It is also interesting to explore how they optimized and strategized the use of limited resources available to them. Our study is part of a larger research project to investigate the transition from a paper record system to an EHR system in a NMPCC. This paper reports our findings from the initial stage of exploring different EHR systems available to the time when a particular system was obtained. The timing that the study was conducted provided us a valuable opportunity to capture early preparation activities that would not be possible in other retrospective studies. 2015 48th Hawaii International Conference on System Sciences 1530-1605/15 $31.00 © 2015 IEEE DOI 10.1109/HICSS.2015.364 3013