Feedback GAP : study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

Peer reviewedPublisher PD

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits

The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients\u27 involvement in healthcare. EHR use has the potential of saving$731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients

Horizontal Violence Effect on Nurse Retention

Horizontal violence is known by a variety of terms such as lateral violence, bullying, and incivility. Christie and Jones (2014) describe lateral violence as a problem in nursing where a behavior is demonstrated through harmful actions that occur between nurses. Studies have revealed how horizontal violence affects nurse retention. Horizontal violence is a relevant issue in the healthcare community, yet often goes undiscussed. Walrafen (2012) explains that an outcome of horizontal violence in nursing is directly proportional to a decrease in retention of nurses. Sherman (2012) proclaimed that nurses who are subjected to horizontal violence have low self-esteem, depression, excessive sick leave, and poor morale. As Wilson (2011) identified nurses, who witness or experience horizontal violence have an increased desire to leave the organization where the bullying takes place. Horizontal violence is a pervasive source of occupational stress with physical, psychological, and organizational consequences (Hauge, et al, 2010). Roy (2007) describes this as an unkind, discourteous manner in which nurses relate to their colleagues. As nurses seek to perform their daily tasks, other co-workers may embarrass them for their lack of knowledge, tease them as they participate in informal cliques, or demean them for their technique (Bakker, 2012). Creating excuses, taunting, and refusing to share information, nursing education or knowledge are examples of horizontal violence (Ball, 1996)

Registered Nurses\u27 Intention To Use Electronic Documentation Systems: A Mixed Methods Study

BACKGROUND: Home care in Ontario has become the fastest growing sector and cornerstone of the healthcare system. As a result of the increased shift to the home care sector in Ontario, there have been several health information technology (HIT) initiatives to improve the quality and delivery of health care services to patients. This is exemplified with the province-wide development and implementation of electronic documentation systems (EDS). Electronic documentation systems have the potential to ensure timely, up-to-date and comprehensive patient health and care-related information is available and accessible to healthcare providers such as registered nurses regardless of their physical location. Access to patient health and care-related information supports high-quality nursing care, decision-making, and care delivery processes. Despite the benefits of EDS (i.e., improved workflow, reduced diagnostic and laboratory tests and adverse drug events), low intention by registered nurses to use these systems is well documented. Existing evidence suggests that an expressed intention to use HIT such as EDS is a direct predictor and antecedent of behavioural usage. Despite the growing efforts to understand registered nurses’ perceptions and overall intention to use EDS in practice, there is limited knowledge about registered nurses’ intention to use EDS in the context of home care practice. AIMS: The purpose of this study was to understand and examine factors that influence nurses’ intention and overall perception of using EDS in their home care practice. The conceptual model framing this study was adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT) to delineate the relationships among factors that influence registered nurses’ intention to use EDS in home care practice. METHOD: A sequential, explanatory mixed methods design, using a sample of nurses from Ontario who are currently practicing within the home care sector were recruited to address the study’s objectives. Data were collected using both quantitative (online survey) and qualitative (semi-structured individual telephone interviews) methods. Quantitative data were analyzed with descriptive statistics and hierarchical multiple regression analysis and qualitative data were analyzed with content and inductive thematic analysis. RESULTS: Individual, technological and organizational / environmental characteristics were found to influence nurses’ intention, level of comfort and experience with EDS usage in home care practice. Additional factors found to influence home care nurses’ experience with EDS usage included: the development and employment of workarounds, the influence of nurse-patient interaction amidst system usage, and the ability to provide input towards the system design. CONCLUSION: Nurses play a significant role in the delivery of home health care services to Ontarians. The findings highlight the importance for: a) further exploration of the most appropriate model and / or adaptation of a model identifying a range of factors influencing nurses’ intention to use EDS in different healthcare contexts; b) continued integration of nursing informatics competencies within nursing curricula; c) an organizational culture that supports the use of EDS in nurses’ home practice (i.e., enlisting user champions and providing adequate training and IT support); and d) having representation of nurses in the EDS design and / or implementation processes through a user-centered design approach

Enhancing the Rigor of Qualitative Research: Application of a Case Methodology to Build Theories of IT Implementation

This paper presents and illustrates how the approach proposed by Eisenhardt (1989) for building theories from intensive qualitative research, more precisely case study research, can help information systems and medical informatics researchers understand and explain the inherently dynamic nature of IT implementation. The approach, which adopts a positivist view of research, relies on past literature and empirical data as well as on the insights of the researcher to build incrementally more powerful theories. We describe in some detail how this methodology was applied in a particular case study on IT implementation in the health care context and how the use of this approach contributed to the discovery of a number of new perspectives and empirical insights. Furthermore, we provide insights into the many choices that a researcher must make when adopting this methodological approach. Overall, using Eisenhardt\u27s approach as a starting point, our objective is to provide a rigorous, step-by-step methodology for using case studies to build theories within the information systems and medical informatics fields. We provide several insights to the nature of case research, information on and concrete examples of specific techniques and tools, and guidance on how to improve intensive case research

Strategies Rural Hospital Leaders Use to Implement Electronic Health Record

The Centers for Medicare and Medicaid Services issued over 144,000 payments totaling $7.1 billion to medical facilities that have adopted and successfully demonstrated meaningful use of certified electronic health record (EHR). Hospital organizations can increase cost savings by using the electronic components of EHRs to improve medical coding and reduce medical errors and transcription costs. Despite the incentives, some rural health care facilities are failing to progress. The purpose of this multiple case study was to explore the strategies rural hospital leaders used to implement an EHR. The target population consisted of rural hospital leaders who were involved in the successful implementation of an EHR in South Texas. The conceptual framework chosen for this study was the sociotechnical systems theory. Data were collected through telephone interviews using open-ended semistructured interviews with 5 participants from 4 rural hospitals who were involved in the EHR implementation. Data analysis occurred using Yin\u27s 5-step process which includes compiling, disassembling, reassembling, interpreting, and concluding. Data analysis included collecting information from government websites, company documents, and open-ended information to develop recurring themes. Several themes emerged including ongoing training, provider buy-in, constant communication, use of super users, and workflow maintenance. The findings could influence social change by making the delivery of health care more efficient and improving quality, safety, and access to health care services for patients

Strategies for Developing and Implementing Information Technology Systems for EHRs

Some hospital leaders lack the technical expertise to implement electronic health records (EHRs) even though the healthcare industry has a government mandate. The purpose of this single case study was to explore strategies healthcare executives use to develop and implement information technology systems for processing EHRs. The target population consisted of healthcare leaders and managers successful in implementing EHR systems in a healthcare organization. Lewin\u27s 3-step change theory was used as the conceptual framework for this study with data collected from observations (5), semistructured interviews (5), and organizational documents. Descriptive coding was used to identify 3 themes that emerged from observations, document analysis, recording and analyzing the interview transcripts of research participants. The themes included communication and management plan for EHR implementation, information technology EHR vendor selection, and EHR implementation technical support strategy. The findings benefit both the patients and clinicians with the potential to improve healthcare service delivery utilizing electronic technology for documenting physician visits. Study results may assist healthcare providers with identifying implementation strategies successful for EHR adoption and assisting with speeding the process. The research findings may contribute to social change through increasing patient access to treatment along with community engagement in using EHRs by information sharing to reduce healthcare cost

Successful Strategies for Implementing EMR Systems in Hospitals

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter\u27s 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles

The Economics of Information Technology in Public Sector Health Facilities in Developing Countries: The Case of South Africa

The public healthcare sector in developing countries face many challenges, including weak healthcare systems and under resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Healthcare delivery, access to healthcare and cost containment has the potential for improvement through more efficient healthcare resource management. Global references demonstrate that information technology (IT) has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of new systems implementations on service delivery, user adoption and organizational culture within the hospital setting in South Africa, as perceived by doctors, nurses and hospital administrators. The research provides some insight into the reasons for investing in system automation, the associated outcomes, and organiztional factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation.Hospital information systems; healthcare management; electronic health records; South Africa, mixed methods