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

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.