As Västra Götalandsregionen (VGR) embarks on the ambitious Millennium EHR project, it’s crucial to draw lessons from past large-scale implementations. A study by Morten Hertzum, Gunnar Ellingsen, and Åsa Cajander provides invaluable insights into the challenges and outcomes of introducing the Epic electronic health record (EHR) system in Denmark and Finland. This study holds significant relevance for VGR’s journey, especially given the concerns raised about Millennium’s implementation, as highlighted in this interview.

The Nordic Experience with Epic

The study focuses on two large-scale Epic implementations:

  • Denmark: The system went live in 2016–2017 across 12 hospitals serving 2.6 million citizens.
  • Finland: Starting in 2018, Epic was rolled out in the Helsinki-Uusimaa region, integrating healthcare and social care for 1.7 million people.

Despite extensive preparation, both implementations faced persistent challenges, including usability issues, productivity dips, and unmet expectations. Five years post-implementation, 32% of Danish users remained dissatisfied, while only 9.3% of Finnish physicians felt the system improved care quality.

Key Takeaways for the Millennium Implementation

  1. Unmet Expectations: Both Danish and Finnish projects suffered from a gap between high pre-implementation hopes and post-implementation realities. The study emphasizes the importance of realistic goal-setting and proactive issue resolution.
  2. Usability Matters: Poor interface design, unclear terminology, and excessive clicks plagued users, leading to frustration. These issues were often exacerbated by attempts to fit a U.S.-centric system into a Nordic healthcare model.
  3. Long-Term Adaptation: Initial productivity dips lasted longer than anticipated, and resolving system issues required years, not months. Planning for extended adaptation is critical.
  4. Workload Redistribution: Shifting documentation tasks to physicians without adequate support led to dissatisfaction. Any similar changes in Millennium need careful consideration.
  5. Localized Customization: Balancing regional standardization with local needs is complex. Both Denmark and Finland struggled to find the right mix, leading to discontent among users.

The study underscores the importance of learning from past implementations to avoid repeating mistakes. These large implementation project must prioritize usability, realistic planning, and user-centered design to succeed where others have struggled. Transparent communication and adaptive strategies will be vital in navigating the complexities of a project of this scale.

For a deeper dive into the study, the full analysis is available in the International Journal of Medical Informatics.