Electronic Health Record Implementation Strategies for Decreasing Healthcare Costs

Some managers of primary care provider (PCP) facilities lack the strategies to implement electronic health records (EHRs), which could decrease healthcare costs and enhance the efficiency and quality of healthcare that patients receive. The purpose of this single-case study was to explore the strategies PCP managers used to implement EHRs to decrease healthcare costs. The population consisted of 5 primary care managers with responsibility for the administration, oversight, and direct working knowledge of EHRs in Central Florida. The conceptual framework was the technology acceptance model. Data were collected from semistructured face-to-face interviews and the review of company documents, including training logs, activity records, and cost information. Methodological triangulation was used to validate the creditability and interpretation of the data in transcribing themes. Three themes emerged from the analysis of study data: implementation of EHRs, costs of implementing EHRs, and perceived usefulness of EHRs. Participants indicated that the implementation of EHRs depended on motivation, financial cost, and the usefulness of EHRs relating to training that reflected user-friendliness. The implications of this study for social change include the potential to lower the cost and improve the efficiency of healthcare for patients. The use of EHR systems could enhance the quality of care delivered to patients through improved accessibility, elimination of duplicative tests, and retrieval of accurate patient information. The use of EHRs can lead to a comprehensive preventative healthcare system resulting in a healthier environment

Managerial Strategies for Maximizing Benefits From Electronic Health Record Systems

In 2009, the U.S. government allocated $27 billion to health care agencies for electronic health records (EHRs) implementation. The increased use of EHR systems is expected to drive down health care costs and increase profits. To meet this anticipated return on investment (ROI), hospital managers need to be able to successfully design, deploy, and manage EHR systems. The purpose of this single case study was to explore organizational management strategies that hospital managers can use to ensure their investments in EHRs meet targeted ROIs and work efficiency goals. The conceptual framework for this study was based on the technology acceptance model. Primary data were collected from a criterion sample of 6 hospital managers with direct experience designing and implementing successful EHRs in a small hospital in the Northeastern United States. Secondary data were collected using public financial records available on the Internet. After cataloging and grouping the raw data, 4 emergent themes were identified: (a) training, (b) the role of organizational management strategies, (c) technological barriers, and (d) ongoing support and maintenance. Findings may contribute to social change through an increase in the quality of patient care and making health care records more accessible to doctors in isolated areas

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Achieving change in primary care—causes of the evidence to practice gap : systematic reviews of reviews

Acknowledgements The Evidence to Practice Project (SPCR FR4 project number: 122) is funded by the National Institute of Health Research (NIHR) School for Primary Care Research (SPCR). KD is part-funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Research and Care West Midlands and by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the NIHR. This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding This study is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR).Peer reviewedPublisher PD

Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation

Resistance of multiple stakeholders to e-health innovations: Integration of fundamental insights and guiding research paths

Consumer/user resistance is considered a key factor responsible for the failure of digital innovations. Yet, existing scholarship has not given it due attention while examining user responses to e-health innovations. The present study addressed this need by consolidating the existing findings to provide a platform to motivate future research. We used a systematic literature review (SLR) approach to identify and analyze the relevant literature. To execute the SLR, we first specified a stringent search protocol with specific inclusion and exclusion criteria to identify relevant studies. Thereafter, we undertook an in-depth analysis of 72 congruent studies, thus presenting a comprehensive structure of findings, gaps, and opportunities for future research. Specifically, we mapped the relevant literature to elucidate the nature and causes of resistance offered by three key constituent groups of the healthcare ecosystem—patients, healthcare organizational actors, and other stakeholders. Finally, based on the understanding acquired through our critical synthesis, we formulated a conceptual framework, classifying user resistance into micro, meso, and macro barriers which provide context to the interventions and strategies required to counter resistance and motivate adoption, continued usage, and positive recommendation intent. Being the first SLR in the area to present a multi-stakeholder perspective, our study offers fine-grained insights for hospital management, policymakers, and community leaders to develop an effective plan of action to overcome barriers that impede the diffusion of e-health innovations.publishedVersionPaid open acces

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

Physician Practice Variation in Electronic Health Record Documentation.

Adoption of electronic health records (EHRs) was motivated by the expectation that they would improve quality and decrease costs of care. EHRs’ value, however, depends on how they are used, which likely explains the heterogeneous benefits observed in the literature. This dissertation uses mixed methods to explore a critical component of EHR use in primary care: variation in EHR documentation, defined as differences in how users record or remove information. The first chapter delineates a conceptual framework of variation in EHR documentation that includes five different forms of variation and five levels where the forms may materialize. This chapter focuses on potentially harmful variation by detailing how non-patient factors foster variation that interferes with clinical decision support, care coordination, and population health management, jeopardizing the efficient delivery of high-quality healthcare. The second chapter measures variation in one form of variation, completion of documentation, in a national sample of primary care practices. Using data from a major EHR vendor, this chapter finds differences in how variably providers complete fifteen different clinical documentation categories and identifies patient’s problems, the provider’s assessment and diagnosis, the social history, the review of systems, and communication about lab and test results as the most varied. The majority of variation exists across providers in the same practice, suggesting providers are making different decisions about documentation for comparable patients. The final chapter explores the context of this variation with semi-structured interviews, finding that variation in EHR documentation is perceived as a commonplace phenomenon resulting from a flexible EHR design that allows users to develop different documentation styles. Variation reportedly introduced inefficiencies into care delivery and created patient safety and care quality risks from missed or misinterpreted information. Respondents identified additional training, ongoing meetings, and improvements in EHR design as effective strategies to prevent harm. Widespread variation in EHR documentation can interfere with care delivery by obscuring the location and meaning of patient information. In order to realize gains from adopting EHRs, practices, vendors, and policymakers must collaboratively develop better interfaces and clearer guidelines to support their effective use.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135900/1/grcohen_1.pd

Advances in Teaching & Learning Day Abstracts 2004

Proceedings of the Advances in Teaching & Learning Day Regional Conference held at The University of Texas Health Science Center at Houston in 2004