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

backgroundFormal 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.

methodsThis 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.

resultsParticipants 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.

conclusionLearning 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.