Date of Award


Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Bethany Rolfe Witham, DNP, FNP-BC

Faculty Reader

Carol McFarland, MN, RN, CNE

Faculty Reader


Executive Summary

Background:Due to budget constraints, many free clinics have adopted EHR systems that are low cost or free of charge. Unfortunately, one of the most popular free EHRs used by free clinic across the country was recently bought out and will no longer offer a free service. This is forcing many free clinics to transition to a different EHR vendor that is willing to provide the EHR system for free.

Purpose: The purpose of this project was to implement a new Electronic Health Record (EHR) system at a free clinic by transitioning from the currently used EHR system to a new EHR system. This project phased out Practice Fusion EHR and implemented Athenahealth EHR. The scope of this project included mapping the current and future workflow of the clinic, working closely with the clinic staff during the transition phase, preparing orientation (user manuals) of the new EHR for new volunteers, and evaluating the process of the transition so that other small clinics can utilize lessons learned from this experience.

Methods: The system development life cycle (SDLC) framework and the American Medical Association’s(AMA) Nine Step Approach were used to guide the implementation of this project (McBride & Tietze, 2016;The Office of the National Coordinator for Health Information Technology [ONC], 2018). A post EHR implementation online quantitative and qualitative survey was collected to evaluate the outcome.

Results: The post implementation quantitative survey of the staff indicated dissatisfaction and lack of proper understanding of the new EHR as the biggest challenge while the qualitative survey showed challenges surrounding training (training method, training time, and training support). The quantitative and qualitative results are related since improper or inadequate training might have led to knowledge deficit and dissatisfaction with the new EHR system.

Recommendations: In the future, free clinics that will transition from one electronic health record (EHR) system to another EHR system will have better success by pursuing the following recommendations. First, although free clinics are staffed with volunteers who have multiple roles outside the clinic, ensuring mandatory mock training is a step that will prove fruitful in the long run. Not scheduling volunteer staff who have not participated in the mock training might encourage the volunteer staff to attend the mandatory mock training. Second, select volunteer staffs that are willing to be trained as superusers and consistently be on the schedule for the first three months of EHR implementation. Third, using the EHR vendor resources, prepare role specific training manuals that are specific to the clinic before the go-live date.

Conclusion: Transitioning from one EHR to another is like implementing a new EHR for the first time; thus, the transition process needs to be approached with the same methodical and careful planning. In the future, as technology advances and health care increasingly integrates with the digital world, small clinics will continue switching to new EHRs to better meet the needs of the clinic, staff, and patients they serve. Thus, the findings of this project can be instrumental for successful EHR transition.


McBride, S., & Tietze, M. (2016). Computers in health care: Nursing informatics for the advanced practice nurse. New York, NY: Springer Publishing Company, LLC.

The Office of the National Coordinator for Health Information Technology (2018). HealthIT playbook. Retrieved from

Additional Rights Information

Copyright held by author.


Copyright Status