Exploring the facilitators and barriers towards implementation of electronic prescribing, dispensing, and administration of medicines in hospitals in Ireland.

Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. The aim of this doctoral research was to explore this under-researched area in three phases. Phase one: - Phase one focused on critically appraising and synthesising the available evidence on healthcare professionals perceptions, attitudes, and views of the facilitators and barriers to implementing electronic prescribing, electronic dispensing, and/or electronic administration of medicines in the hospital setting. The review protocol was registered with the Centre for Reviews and Dissemination and conducted according to best practice. Key facilitators included systems improved patient safety and provided better access to patients drug records and that team leadership and hardware/software availability and reliability were essential for successful implementation. Key barriers consisted of hardware and network problems, altered work practices, and weakened interpersonal communication between healthcare professionals and with patients. Phase two: - This phase employed a qualitative phenomenological design to gain original insight into the perceptions of local key stakeholders towards the facilitators and barriers to implementing prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospitals in Ireland using Normalization Process Theory as a theoretical framework. Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two hospital Information Technology managers. Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multidisciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Phase three: - A similar qualitative methodology was employed in phase three of this research in order to explore the perceptions of national key stakeholders and eHealth leads towards the facilitators and barriers to system implementation. Sixteen consenting invitees participated: eight hospital leads, four government leads, two regulatory leads, and two academics. Key facilitators included enhanced patient safety, workflow efficiencies, improvements in governance, and financial gains. Perceived barriers included the introduction of new drug errors, loss of patient contact, initial time inefficiencies, and issues with the complexity of integration and standardisation of work processes. Overall, adequate technology, stakeholder involvement, and organisational leadership and support are required at a national and local level to drive the eHealth agenda forward. Testing at scale, contingency plans, and ongoing evaluations will assist in determining success or otherwise of system implementation. This research has generated novel findings with many potentially transferable themes identified which extend the evidence base. This will assist organisations to better plan for implementation of medication-related eHealth systems

Linking Health Information Technology to Patient Safety and Quality Outcomes: A Bibliometric Analysis and Review

Informatics for Health and Social Care is published by Informa Healthcare. Publisher's version can be found at: http://informahealthcare.com/doi/abs/10.3109/17538157.2012.678451OBJECTIVE: To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that published knowledge relevant to the impact of health information technologies on patient safety and quality of care outcomes. STUDY DESIGN: We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In addition, we performed a qualitative review of the full-text articles and grant documents. DATA COLLECTION/EXTRACTION METHODS: Papers published by AHRQ-funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson Reuters Journal Citation Report, citations were retrieved from ISI's Web of Knowledge and Google Scholar. PRINCIPAL FINDINGS: Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQ's outcome goals and focus priorities. The average impact factor for the journals was 4.005 (range: 0.654-28.899). The articles, and their respective grants, represented a broad range of health information technologies. CONCLUSIONS: This set of AHRQ-funded research projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge base on the impact of information system use in healthcare.This work was supported, in part, by the National Resource Center of the Agency for Healthcare Research and Quality, contract number 290-04-0016

The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview

Aziz Sheikh and colleagues report the findings of their systematic overview that assessed the impact of eHealth solutions on the quality and safety of health care

Promoting Clinical Engagement and Cross-sector Collaboration Through Changes in Workforce, Use of Technology, and Improved Business Systems

Published version made available here with permission from publisher.Background: Cross-sectoral collaboration across health care settings has the potential to deliver efficiencies as well as improve health care outcomes. There is a need for better understanding and awareness of models, mechanisms and strategies that enhance crosssectoral collaboration in Australia. Improved cross-sectoral collaboration is supported by a number of changes in workforce, use of technology and improved business systems. This review seeks to summarise these programs for those who may be seeking to engage in this area as a means of determining the range of options and possible proven benefits. Methodology: This study employs a mixed methods approach. A pragmatic literature review was undertaken to determine the relevant collaborative care models and review current programs Australia-wide that implement these models. Programs were selected from searching the grey and indexed medical literature as well as suggestions obtained from relevant stakeholders. Criteria for inclusion included having description in the peer reviewed and grey literature, ability to represent a unique model, extent of current use and description of outcomes of the intervention. Additional qualitative semi-structured interviews were conducted to elucidate more detailed information about technology, workforce and business systems. This information is summarised in the report and details about the individual programs are included as an appendix to this report. Results: Fifteen models were reviewed for this report. Qualitative semi-structured interview data were employed to supplement findings from the literature review. Key mechanisms of these models are described specifically focusing on the use of technology, workforce and business systems. Facilitators and barriers were identified and explored

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Working Paper]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use

Health Information Technology in the United States: Driving Toward Delivery System Change, 2012

Examines progress on electronic health record adoption, health information exchange under the HITECH Act, and models for meaningful delivery system reform through health information technology. Includes interview with former national HIT coordinator

Electronic Health Record Functionality Needed to Better Support Primary Care

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This manuscript presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and Meaningful Use (MU) objectives to define EHR functionality. Current objectives remain disease- rather than whole-person focused, ignoring factors like personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time as well as patient partnering activities, support for team based care, population management tools that deliver care, and reduced documentation burden. While Stage 3 MU’s focus on outcomes is laudable, enhanced functionality is still needed including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies

An Integrative Review of the Literature on Technology Transformation in Healthcare

Healthcare transformation through technology is a core objective of health reform. It is important for decision makers to understand the likelihood that reform policies will in fact transform. This study evaluates evidence of technology transformation in healthcare through an integrative review of the healthcare and business literature, guided by the theory of punctuated equilibrium (TPE). TPE describes the process of transformation within organizations, markets, and groups. The theory explains transformation as a pattern of long periods of incremental change (equilibrium) punctuated by short periods of dramatic change (revolution). An underlying deep structure defines the environment of the organization, market, or group. Radical change in the deep structure of the environment is necessary for transformational change. This integrative review covered the period January 2004 through April 2012. The inclusion criteria required that the article or study address both the implementation of health information technology in the United States and describe one of the three components of TPE. Five hundred twenty articles focusing on transformational change were identified through structured database searches of MedLine/PubMed, Business Source Complete, Social Science Research Network, and others. The articles were reviewed, and coded using the three elements of TPE. A directed content analysis of the coded data produced 10 themes describing the three TPE elements: variations in the environment, market complexity, regulation, flawed risk and reward, theories of technology acceptance, barriers, ethical considerations, competition and sustainability, environmental elements of revolution, and internal elements of revolution. The results describe a healthcare market exhibiting strong equilibrium and substantial resistance to change from HIT. Minimal descriptions of the revolutionary element of TPE were evident. The deep structure of healthcare indicates that the historical provider and hospital-centered market prevails. Conditions that might encourage alteration of this deep structure were: empowering and engaging patients; updating care delivery models; and reducing market uncertainty. The revolutionary changes seen in other complex markets from banking to travel to manufacturing relied heavily on the power of the consumer to alter deep structure. Although the concept of patient centeredness was present in the literature there was little clarity regarding the patient as an agent of structural change. To our knowledge this is the first application of TPE to investigate technology transformation in healthcare. Others have demonstrated TPE as a viable model for explaining transformational change in other markets. The study is limited by the study timeframe and the absence of newer literature reflecting the impact of recent policy changes. Despite this limitation the findings suggest that TPE presents a potentially valuable framework to guide evaluation of the progress of policies that encourage transformation from technology. Some propose that altering the complex deep structure of healthcare may require a complete destruction of existing processes before new processes, innovations, and technologies can emerge. The Affordable Care Act (2010) and the meaningful use provisions of the HITECH Act (2009) are moving healthcare toward new patient centered models of care. Uncertainty around the future of reform policies from possible repeal or amendment likely contributes to resistance to transformational change. This may perpetuate the historical rational and incremental pattern of HIT advancement. Patients as consumers have the potential to influence change given the appropriate tools. The importance of consumers to the transformation process suggests that policies fostering technologies that integrate patients into new care delivery models are likely paramount to realizing technological transformation

The challenges of using information communication technologies in the healthcare systems in Ethiopia from provider's perspectives

The adoption of eHealth is very slow despite evidences showing its benefits. This research examines the individual, clinical, technical and organizational challenges for eHealth adoption from healthcare provider‟s perspectives. A cross-sectional study design with a quantitative paradigm was used. The study was conducted on 312 doctors and nurses randomly selected from ten hospitals in Addis Ababa, Ethiopia. Most respondents viewed eHealth positively with no significant differences in terms of profession or gender. Computer skill, workload, patient interaction, management support, cost and infrastructure were the main concerns. Privacy and security were not the main concerns. Knowledge of eHealth applications and utilization was low, even for evidence-based medicine and online databases. Specialists and males were better aware of eHealth applications. The study showed that eHealth acceptance was good. Increasing eHealth literacy was recommended as a cost effective means for improving access to updated information to improve the quality of healthcare.Health StudiesM.A. (Public Health (Medical Informatics)

General practitioners’, pharmacists’ and parents’ views on antibiotic use and resistance in Malta : an exploratory qualitative study

Background: Antibiotic resistance (ABR) remains a global health threat that requires urgent action. Antibiotic use is a key driver of ABR and is particularly problematic in the outpatient setting. General practitioners (GPs), the public, and pharmacists therefore play an important role in safeguarding antibiotics. In this study, we aimed to gain a better understanding of the antibiotic prescribing-use-dispensation dynamic in Malta from the perspective of GPs, pharmacists, and parents; Methods: we conducted 8 focus groups with 8 GPs, 24 pharmacists, and 18 parents between 2014 and 2016. Data were analysed using inductive and deductive content analysis; Results: Awareness on antibiotic overuse and ABR was generally high among interviewees although antibiotic use was thought to be improving. Despite this, some believed that antibiotic demand, non-compliance, and over-the-counter dispensing are still a problem. Nevertheless, interviewees believed that the public is more accepting of alternative strategies, such as delayed antibiotic prescription. Both GPs and pharmacists were enthusiastic about their roles as patient educators in raising knowledge and awareness in this context; Conclusions: While antibiotic use and misuse, and knowledge and awareness, were perceived to have improved in Malta, our study suggests that even though stakeholders indicated willingness to drive change, there is still much room for improvement.peer-reviewe