Implementation research is often focused on the early stages of the implementation process [ 26] however, there is also a need to examine later stages of implementation, including the integration of innovations into the norms and practices of organisations.
During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose.
Since the study was conducted in the early stages of the implementation of the NHIS in 2007, some of the observed problems (e.g. shortages of drugs, payment for services and drugs that should be covered by insurance, payment for uncovered drugs and tests, etc).
Further, in the Precaution Adoption Process model, Weinstein has proposed an additional early stage when individuals may be unaware of the need for behaviour change, a stage which may have particular relevance to the early stages of the implementation of evidence [ 40].
Senior clinicians were often (particularly in the early stages of the implementation) less likely to be affected directly by the system on a daily basis than their more junior colleagues (though this to an extent depended on the system in question and the specialty).
Communication between different professional groups was described as difficult in the early stages of the implementation of a community health team but improved over time when professionals became "aware of each other's public health work, more confident in contacting each other to ask questions, and were beginning to share skills" [ 60].
Applying these theories to super users in EHR implementation, these theories suggest that the behaviors of super users – who are salient because of their formal role in a large change effort – influence the beliefs and EHR use of their peers, particularly in the early stages of the implementation process when employees are first learning how to use the EHR system in their day-to-day work.
The Key Informant Interviews were undertaken in 2008 (12 participants), in the early stage of the HSSMP implementation [ 18] and again in 2012 111 participants).
At the early stage of the NCMS implementation, the percentage of government reimbursement was relatively low, below 20%, which implied that the protection from financial catastrophe was not sufficient and financial barriers were not removed.
There are common approaches which focus on the early stage of the IPS2 development, thereby the implementation phase appears untended.
