Shoulder-to-shoulder: healthcare professionals' experiences of learning during electronic health record implementation in municipal primary care.

Clinical Snapshot

Key Findings

• P Value: Not applicable for qualitative research

• Effect Size: Not applicable for qualitative research

• Primary Outcome: Healthcare professionals experienced formal EHR training as poorly aligned with their digital competencies and clinical work context

• Nnt Or Sensitivity: Key finding: 'Shoulder-to-shoulder' peer learning emerged as crucial adaptive practice compensating for inadequate formal training

• Confidence Interval: Not applicable for qualitative research

Clinical Application

Peer-based learning strategies are highly feasible and cost-effective, requiring minimal additional resources while leveraging existing workplace relationships Highly relevant to Australian primary care given similar challenges with EHR implementation, workforce constraints, and need for contextual learning support in PHNs and general practice Healthcare professionals in primary care settings implementing new EHR systems, particularly in resource-constrained environments

Abstract

BACKGROUND: Formal training is commonly used in electronic health record (EHR) implementation, but often fails to address healthcare professionals' ongoing, context-specific learning needs. There is limited knowledge of how learning unfolds in practice when such training is experienced as insufficient, particularly in municipal healthcare services. METHODS: This qualitative study examined learning processes during the implementation of a new EHR system in a municipal healthcare institution in Central Norway. Data was generated through interviews and observation, and was analyzed thematically. RESULTS: Participants experienced formal training as poorly aligned with their digital competencies and everyday clinical work. Limited time and staffing further constrained participation in formal training and follow-up. Alongside formal training, employees engaged in peer-based learning practices embedded in everyday work, described as 'shoulder-to-shoulder' learning. These practices became particularly important due to limited time and staffing, enabling rapid problem-solving and mutual support, while also reinforcing shared responsibility for learning. Rather than merely compensating for inadequate training, shoulder-to-shoulder learning emerged as an important adaptive practice that supported problem-solving and collaboration during EHR implementation. CONCLUSION: Learning to use EHR systems in municipal primary care should be understood as a socially embedded and ongoing process. While formal training may provide initial orientation, implementation strategies should also recognize and support peer-based learning practices that support ongoing learning and collaboration during periods of organizational change.

References

1. 1.Wiggen, C. U., Anthun, K. S., Håland, E., & Lillefjell, M. (2026). Shoulder-to-shoulder: healthcare professionals' experiences of learning during electronic health record implementation in municipal primary care. Scandinavian Journal of Primary Health Care, 44(4), 1-8. https://doi.org/10.1080/02813432.2026.2673131