Abstract
OBJECTIVE: This study explored experiences with implementing and using the Epic electronic health record (EHR) across different clinical programmes within a single Canadian hospital system and specifically examined how local configuration decisions and implementation of its features and functionalities integrated well or introduced friction within workflows. DESIGN: Qualitative description methodology involving semistructured interviews analysed using thematic analysis. SETTING: A large community hospital in Canada. PARTICIPANTS: Healthcare providers, administrative staff and clinical leaders from seven clinical programmes. RESULTS: 66 individuals participated in interviews. Participants described that Epic's implementation impacted communication and teamwork, workflow and efficiency, and patient care, with these impacts varying across different programme settings. Participants reported that Epic improved inpatient care and safety, communication and teamwork, workflow and efficiency. However, several programmes also experienced challenges, including information overload and increased clerical tasks, impacting workflow efficiency. In programmes with an outpatient component, such as surgery and oncology, there were additional difficulties, such as connecting with external partners, user interface complexities that hindered task completion and concerns about potential compromises in patient care quality. CONCLUSION: Health systems must consider the diverse needs of various clinical programmes when implementing an EHR. Customising the system interface and iteratively codesigning how health system staff incorporate the technology into their workflows are crucial to ensure an EHR seamlessly integrates across different settings, fosters high-quality care delivery and minimises user friction.