Assessing Electronic Health Record Implementation Challenges Using Item Response Theory

OBJECTIVES: To assess the importance of commonly identified issues in electronic health record (EHR) implementation using item response theory (IRT). STUDY DESIGN: Secondary data from the 2012 American Hospital Association's Annual Survey Information Technology Supplement were used in the analyses. Results were compared and contrasted with the standard descriptive statistic frequencies that have been used to guide most recommendations made using the same data. METHODS: IRT was used to measure the magnitude of difficulty that particular challenges pose in implementing EHRs that meet federal guidelines for Meaningful Use. RESULTS: The IRT analyses yielded significantly different results from descriptive statistics in estimating the magnitude of specific EHR implementation challenges. In particular, IRT revealed that "obtaining physician cooperation" and "ongoing costs of maintaining and upgrading systems" were the most challenging implementation features. However, the frequency counts identified "upfront capital costs" and "complexity of meeting Meaningful Use criteria within implementation timeline" as the most challenging implementation features. CONCLUSIONS: For managers and policy makers, having an accurate assessment of EHR implementation challenges is essential to designing effective programs. IRT provides a statistical approach that allows prior studies to be assessed more accurately and future studies to retain the easier-touse, check-all-that-apply survey structure while gaining valuable information.