Table 1 Participants and sites
IDParticipant role and backgroundsCharacteristics of organisationEMR/EHR implementation
P1Program Management Officer, a primary developer of the EHR system; currently leads communication and marketing team for a program to modernise the systemA public, not-for-profit organisation with 150 medical centres and about 1400 outpatient clinics and facilitiesHomegrown system developed in late 1990s; implemented in pilot sites then spread out
P2Informatics Nurse, helps facilitate the optimisation process, develop and approve policies that relate to the EHR and liaison to different departmentsNot-for-profit, integrated health system including 16 acute care hospitals, about 23,000 employees, 3800 licensed beds, ‘QUEST Award for High-Value Healthcare’ Premier Healthcare Alliance, ‘Top Performer on Key Quality Measures’®Implemented an integrated EHR 2006–2011. First two hospitals implemented in phases, the rest implemented big bang approach. Enterprise HIMSS Davies Award of Excellence
P3Director of Inpatient Clinical ApplicationsNot-for-profit, integrated health system including five hospitals with more than 95,000 admitted patients in 2014. Malcolm Baldrige National Quality Award recipient.Had a homegrown system. Implemented an integrated EHR system in 2012 in a big bang approach
P4Vice President of Clinical Information, primary role is to understand and prioritise physician requests to update the electronic medical record for inpatient applications, a physicianNot-for-profit, integrated health system including 12 hospitals and 250 plus sites of care. Six hospitals Magnet® statusImplemented an integrated EHR in 2003. HIMSS Davies Organisational Award
P5Chief Health Informatics Officer, responsible for enterprise-wide systems regarding strategically planning and supporting the facilities using information technology and the health IT, a nurse executiveA division of a national health system in the Northwest region. It includes eight medical centres with 1601 beds and 51 outpatient clinics and facilities. Had over 3.44 million patient visits in 2014Implemented an integrated EHR system 1998–2000. Implemented a clinical information system used in ICU’s in 2010.
HIMSS Davies Organisational Award
P6Director of IS & Clinical Informatics, responsible for overall adoption, implementation and support of the EHR, a nurse executiveNot-for-profit, integrated health system including five hospitals with over 24,600 admissions in 2014Ambulatory EMR in 2003, $140 M Inpatient EHR Implemented 2007–2008. Go-live of two more hospitals in 2010 and 2012–2013. HIMSS Davies Organisational Award
P7Assistant Chief Medical Information Officer, a core team responsible for reviewing and approving changes/content within the EHR; a health information management sub-committee member, a physician lead, an urologistA public 730-bed teaching hospital with more than 32,000 annual admissions. Nationally ranked in seven specialities in Best Hospitals by the U.S. News & World Report 2015–2016Implemented an integrated EHR in 2009. HIMSS Enterprise Davies Award
P8.1Informatics NurseSame organisation. Not-for-profit integrated health system with 70 facilities including three hospitals. It serves more than 1.2 million patients annually. Recipient of Malcolm Baldrige Award. Magnet recognition from the American Nurses Credentialing Centre 2014Implemented ambulatory EHR in 2007 and inpatient in 2011 (same integrated EHR)
P8.2System Analyst Supervisor supervising all the clinical applications for inpatient and outpatient EHR.
P8.3Analyst for inpatient applications, a nurse
P8.4Analyst trainee for inpatient applications, a nurse
P9Associate Chief Medical Officer of Innovation, optimised an EMR system for about 12 years, a physicianIntegrated health system, here outpatient focus as a hospital group, the medical group was merged by a large hospital group in 2014Implemented inpatient EHR 2001. Different vendor ambulatory EHR in 2014 after merger
P10Director of Clinical Informatics and EHR Optimisation, helps IT to prioritise optimisation and responsible for building clinical applicationsNot-for-profit health care system including eight hospitals with more than 168,000 admissions in 2013. Ranked nationally by U.S. News & World Report, with 10 specialitiesImplemented an integrated EHR in 2007–2010
P11Director Health System Informatics, responsible for all of the training and end-user optimisation work with regard to EMR end usersAcademic medical centre with more than 900 beds. ‘America’s Best’ by U.S. News & World Report in 11 specialities in 2010, Nursing Magnet statusAmbulatory EMR in 2008, implemented an integrated inpatient EHR in 2011. HIMSS Stage 7
P12Director of Information Technology, served as Optimisation ManagerTop 50 in 2015–16 America’s Best Hospitals rankings in U.S. News & World Report, Quest for Quality award by the American Hospital Association. Magnet® status 2009$237 M EMR project approved in 2005 – the largest and most complex project. Implemented an integrated EHR in 2007–2008. HIMSS Davies Enterprise/Organisational Award

ICU = intensive care unit.