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Question: Discuss About The Journal Community Hospital Internal Medicine? Answer: Introduction Electronic medical records (EMR) represents "an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization" (Chang Gupta, 2015). EMR further serves as one of the key developments in healthcare settings which have substantial benefits to physicians, clinical practices, and healthcare organizations. Besides, EMR improves patient care by enhancing communication between multiple healthcare providers and the patients, reduces the risk of medical errors and promotes safe practice (Palabindala, Pamarthy Jonnalagadda, 2016). In this regard, the associated positive effects of EMR in healthcare settings is profound. However, the adoption of the technology and effective integration in practice both primary care setting and hospitals experience significant challenges. However, healthcare can adopt different change management practices to mitigate against major barri ers to the adoption of EMR. The report will explore the adoption of EMR in an existing 800-bed tertiary teaching hospital based on the possible barriers and effective approaches to mitigate the barriers or ensure integration in healthcare practice. Possible Barriers to EMR Adoption EMR adoption in healthcare setting requires effective change management approaches since it's based on changing healthcare practices thus high chances of experiencing barriers. Some of the possible barriers to effective adoption of EMR involves the acceptance barrier by the healthcare providers primarily healthcare professionals with little or less knowledge on the use of the technology. Acceptance barrier serves as the greatest challenge of EMR adoption which creates the need for the healthcare leaders to have effective change management practices (Hamid Cline, 2013). Acceptance challenge is also more common when the healthcare stakeholders are not involved in the decision regarding the adoption of EMR. According to Ajami Bagheri-Tadi (2013), the majority of the healthcare professionals having acceptance issues are influenced by the perception towards EMR and poor understanding of the role and operation of the technology in healthcare practice. Another possible barrier to EMR adoption involves the overall cost of adoption. According to Khalifa (2013), EMR requires healthcare organizations to make significant investments in purchasing the EMR system as well as training the healthcare providers on the effective use of the system in order to achieve the maximum benefits. Besides, the adoption of the system creates the need for the healthcare organizations to invest in information technology resources which increases the overall costs of full adoption of the system. The associated costs of adoption are significantly high which serves as a possible barrier to EMR adoption primarily among healthcare organizations that are not well funded (Ajami Arab-Chadegani, 2013). The inability of the EMR system to meet the healthcare organization needs or fit its purpose can also serve as a key barrier to effective adoption. EMR is expected to solve key problems in healthcare settings such as communication between different healthcare providers in regards to patient care or ensure efficient access to patient information. However, in situations where the designed EMR does not fit its purpose, there is a possibility of experiencing barriers or challenges. Additionally, the ability of the ability of the system to integrate with other existing electronic system or healthcare practices can lead to barriers creating the need to adopt systems that are flexible and can be easily integrated with different systems within the healthcare settings (Esquivel, Sittig, Murphy Singh, 2012). The aspect is common when the system design fails to include the clinical processes and workflow. As an 800-bed tertiary teaching hospital the adoption of EMR is critical; however, the po ssibility of challenges are high due to the number of clinical practices and systems that must be integrated to achieve positive outcomes. As such, the inability of the system to effectively address the key clinical practices and systems serves as a key barrier to adoption. Another significant barrier involves the lack of skilled workforce and resources that can ensure continued support for the system. Majority of the healthcare providers lack the necessary skills to effectively adopt new technologies which create concerns when such systems are introduced in healthcare settings. Besides, the majority of the care providers have concerns about the system becoming obsolete which limits their support or acceptance of the EMR system. The key barriers demonstrate that healthcare organizations require effective leadership and the need to demonstrate the importance of EMR's in transforming healthcare functions such as safety, quality, and care efficiency. Different mitigation measures can be adopted prior to the adoption of the system to enhance the success rate in the implementation process (Granlien Hertzum, 2012). Mitigation to Overcome the Barriers Effectiveness in Real World It's evident that EMR adoption is likely to face key barriers, however, different approaches can be adopted to mitigate and overcome the barriers. The first key approach involves the inclusion of all the stakeholders in decision-making regarding the implementation of the EMR system. Healthcare organizations should engage its stakeholders to educate them on the need for the system as well as seek their opinion. The approach plays a significant role in enhancing the support for the system during the adoption or implementation stage (Hamid Cline, 2013). Besides, the approach is effective in reducing the negative perception in real-world implementations which influence the healthcare providers decision to reject the systems. Additionally, the approach is deemed effective since it increases the feelings of inclusion in decision-making as well a motivating the healthcare providers. Additionally, McGinn et al., (2011) notes that engaging the stakeholders provides the opportunity to clear d oubts on the system, present its key components and demonstrates its advantage towards improving the healthcare practice thus achieving greater support. The second key mitigation approach involves establishing a strong change management and communication strategy within the healthcare institution. The approach is critical in preparing the healthcare staff for changes in the clinical practice. Additionally, the communication strategy is effective in communicating the need for the system to the healthcare setting as well as its key components. Change management helps adopt an effective strategy to enhance the acceptance to change by creating an implementation strategy or support levels based on different leadership levels in the healthcare settings (Neumeier, 2013). The approach further helps focus attention on the positive effects of EMR to the healthcare practices rather than the associated costs, skills or resources. As such it contributes in shaping the healthcare professionals perception or negative attitude towards the system. Another key mitigation measure involves establishing training and development program for the EMR users to enhance their chances of fully using the system to achieve the maximum benefits. Training is critical in reducing the barriers associated with lack of knowledge and skills on EMR among the healthcare providers. In real life situations, the case is evident since the majority of the healthcare professionals lack the technical knowledge to adopt the system which influences their resistance towards change (Esquivel, Sittig, Murphy Singh, 2012). However, the healthcare organization investment on training and development empowers the workers ensures knowledge required to effectively use the system. Another key mitigation approach involves enhancing the healthcare settings investments in technology. The approach helps in addressing the resources challenge and ensures the healthcare settings have the necessary resources necessary to fully adopt the system such as communication systems (El Mahalli, 2015). Besides, resources help in the continued maintenance of the EMR in the healthcare setting as well as providing the users with continued support. The approach is effective in real-world implementations such as the healthcare setting with 800 beds suggesting that it serves a large number of patients. In this regard, accessing each patients records is challenging creating the need for the EMR system and the key resources such as computers, servers, and networking tools among others. The approach further translates to safe healthcare practice as well as the improvement in the quality of care provided to patients (Souther, 2012). Strong leadership in the healthcare organization can also help in mitigating the barriers as well as supporting full adoption of the system. Leadership promotes the chances of resolving issues or problems as well as addressing key setbacks that affect the timely implementation of the system such as financial resources. Effective leadership further help in communicating the need for EMR and have better chances of influencing support from other healthcare professionals (Kruse et al., 2015). Strong leadership also helps in advocating support for the EMR as the solution to a broad range of healthcare challenges such as medical errors. Another key approach involves the design of an organization-based system that is based on addressing the specific needs of the healthcare system. Such an approach is critical since it ensures the inclusion of all the clinical practices and user needs thus promoting the overall implementation process. Besides, it ensures the system is flexible with the chang ing nature of the organizational needs. The approach is effective in real-world situations since healthcare organizations vary in size or the number of patients served suggesting that a universal system may be ineffective (Devkota Devkota, 2014). Another key mitigation measure involves shaping the EMR to align with the organizational goals and priorities such as patient safety and quality of care. The aspect helps in communicating the positive impact of adopting EMR as part of the patient safety improvement. Additionally, the approach helps address the public concern on patient safety primarily in the current world characterized by increasing cases of medical errors and patient safety challenges. The aspect is also critical in real-world situations since it ensures operation in accordance with the existing laws or policies in the healthcare system (Esquivel, Sittig, Murphy Singh, 2012). Conclusion The review presents the notion that EMR is critical in healthcare settings since it impacts positively on patient safety, quality of care and clinical practice. However, the effective adoption of EMR in healthcare settings has significant barriers that limit its effectiveness. Some of the key barriers involve acceptance by the key stakeholders, overall costs, and resources required, technical skills and perception towards the system. However, different mitigation measures have been put forward and can also be adopted in a real world situation where they have demonstrated effectiveness. Some of the mitigation measures include strong leadership in the healthcare organizations, the inclusion of all the stakeholders in decision-making, proper change management and communication in regards to the system need. Additionally, the creation of EMR that is specific to the healthcare organization needs can also help in achieving positive outcomes. 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