My capstone project is focused on patient's safety related to EHR implementation. One of the challenges of implementing an electronic health record (EHR) is change (McGonigle & Garver Mastrain, 2012) (change management, 2012).Three phases of change: un-freeze, change and refreeze make up Lewin's Change Theory. Each of these stages offers a specific understanding to the process and the implementation of a new technology. Unfreezing according to Lewin is the phase that attempts to prepare the staff for the upcoming implementation. The implementation process, or change, then begins with the process of transition and training of the new EHR. TAM or Technological Acceptance Model is identified as a successful method for electronic health record implementation processes. TAM focuses on the behavior of students and their intent to accept the new process (Wade & Schneberger, 2006) (change management, 2012). This intent, or use, is promoted when users feel free to act without the limitation of time or organizational protocols. Facilities often employ the TAM theory in the implementation of new EHR components. Many software systems offer multiple ways to input information (McGonigle & Garver Mastrian, 2012) (change management, 2012). Instructing on the most common way sets a standard for all users. Efficient workflow is added to the training design and assists user with the concerns of time management. Instructing users on how to use the system as an improvement to current workflow processes is important and promotes change acceptance (change management, 2012).

An existing EHR environment the important concept I take away from TAM is this basic concept that the more the users perceive that the new technology will be useful to them and easy-to-use the more they'll likely to accept it (Zhang & Xu, 2011). This highlights the importance of selling the benefits of new technology to the intended users before it is into place and to provide adequate training to make the transition to the new technology goes smoothly as possible.

Kotter's eight step model for change management (Campbell, 2008). For me the steps encounters model layout a systematic process that

Gain acceptance for the changes and workflow that users will need to make as they adapt to voice recognition dictation. The eight steps of the Kotter model for managing change;

1) Create a sense of Urgency

2) Build a Guiding Coalition

3) Form a Strategic Vision and Initiatives

4) Enlist a Volunteer Army

5) Enable Action by Removing Barriers

6) Generate Short-Term Wins

7) Sustained Acceleration

8) Institute Change.