Status and trends of e-Health tools in Kuwait: A narrative review

Background: Kuwait is witnessing an alarming increase in diabetes and high prevalence of multi-drug resistant strains. E-Health solutions have the potential to deliver timely, quality and cost-effective solutions to these public health challenges. However, little is known about the existing e-health solutions in Kuwait. Aims: This study aims to explore the current e-health tools and applications in Kuwait, and the factors that affect their adoption and implementation. Methods: A literature search was carried out for articles on e-health in Kuwait using the following electronic databases: PubMed, Google Scholar, Scopus, Web of Science, CINAHL, Medline and Proquest. Reference lists of all included items were additionally searched. A manual search was also conducted using WHO EMRO Virtual Health Sciences Library and MOH policies and standards. Results: 1121 papers were retrieved from databases and 29 papers were added from manual searching of reference lists. 495 papers were considered for review after the removal of duplicates. Thirty studies met the inclusion/exclusion criteria. Implementing electronic health records and establishing a childhood-onset diabetes registry are the main e-Health achievements to date. Implementing e-Health tools has been hindered by various socio-political, financial, infrastructural, organizational, technical and individual barriers. Conclusion: The modest e-Health achievements warrant bigger and faster implementation steps focusing on developing an e-Health policy framework and drawing an implementation road-map that is evidence based and research informed

A systematic review of the adoption and acceptance of eHealth in Saudi Arabia: views of multiple stakeholders.

Background: eHealth is defined as “the use of information and communication technology for health”. Adoption and acceptance are key concepts to measure the level of eHealth impact. The aim of this systematic review was to critically appraise, synthesise and present evidence of the status of eHealth adoption and acceptance in Saudi Arabia from the perspectives of multiple stakeholders. Methods: Based on a Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) guided protocol published with the international prospective register of systematic reviews (Prospero), five databases were searched for articles published between 1993 and 2017. Inclusion and exclusion criteria of studies were applied in which only peer-reviewed, full-text primary research articles in English language were included. One reviewer performed the searches; two reviewers independently screened the titles then abstracts followed by full articles. Studies excluded were recorded with reasons. Critical appraisal tools appropriate to study design were applied. Eleven items from every study were extracted for further synthesis. Results: After duplicates were removed, 110 papers were screened, and 15 studies met the inclusion criteria. Studies were generally of good quality. Thirty-nine factors were identified as influences affecting the adoption and acceptance of eHealth in Saudi Arabia. Lack of eHealth studies from the perspective of health managers and the limitation of studies to few geographical areas were identified as knowledge gaps. Conclusion: eHealth field in Saudi Arabia showed evidence of continual growth in both publications and awareness of significance. Therefore, findings from this review may help key professionals to address the current challenges and barriers and prioritise the main areas for improvement

A qualitative study of physician perspectives on adaptation to electronic health records

BACKGROUND: Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. METHODS: We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. RESULTS: We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. CONCLUSIONS: As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians

A RAPID REVIEW OF PHYSICIAN BURDEN SECONDARY TO ELECTRONIC HEALTH RECORDS USE IN THE UNITED STATES FROM 2015 TO 2020

Background: After the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been a tremendous increase in the number of hospitals and providers adopting and using Electronic Health Records (EHRs). While EHRs were a way of improving efficiency, quality, and safety of healthcare, there is emerging evidence that they are contributing to physician burden, which can take the form of increased workload, decreased satisfaction, negative attitudes, and burnout. For instance, Arndt et al. found that physicians spent half of their workday on the EHR during and after work, and Robertson et al. found that time spent on the EHR after hours was associated with burnout and decreased work-life balance. Purpose: This capstone project is a rapid review of the research on physician burden and EHR use in the U.S. between January 2015 to February 2020. Its purpose is to assess recurring themes within recent literature focused on EHR-related physician burden. Methods: Articles were found on PubMed using MeSH terms. Physician burden was defined by four MeSH terms: “burnout, psychological”, “workload”, “job satisfaction”, and “attitude of health personnel.” Articles were assessed based on inclusion and exclusion criteria. Inclusion criteria were 1) research articles, 2) sample populations in the US, 3) English language, 4) articles focused on physician burden and EHR use. Exclusion criteria were non-research articles, study populations outside of the US, not in English, and not focused on physicians, physician burden, or EHR use. The PubMed search resulted in 174 results and 21 articles were found from other sources. The articles were assessed based on their abstracts then their full text. After assessment, 28 articles met inclusion criteria. The 28 articles were then grouped based on quantitative vs qualitative methods, data types, and specific major themes. Results: Twenty-eight articles were included in the rapid review. Twenty-seven articles used quantitative methods and 1 article used qualitative methods. Of the 27 quantitative articles, 16 used surveys, 6 used log data, 2 used direct observation and 3 used a mix of quantitative methods. The one qualitative study used interviews. Major themes were burnout, workload, satisfaction, attitudes, and time tracking. The number of respondents with burnout ranged from 24.1% to over 60%. Six out of nine articles found burnout associated with not enough time on documentation, high total amount to EHR use, EHR use after work, low EHR usability, and higher number of in-box messages. For satisfaction, 4/8 studies found a negative association between satisfaction and EHR use, while the other 4 articles found either positive satisfaction with EHR use or no association between EHR use and overall job satisfaction. Workload increased with EHR use in the form of increased effort processing in-box messages, generating after visit summaries, increased administrative time, increased time on documentation and chart review. Negative attitudes included inaccurate information and decreased meaningful patient-provider interaction. Positive attitudes included faster lab results and better provider communication. Around half of clinic time is spent on the EHR and after work EHR use ranged from 21 minutes to 2.5 hours. Conclusion and Implications: Physician burden is a growing issue in the U.S. and EHR use is an unintended contributor to physician burden in the form of increased burnout and workload. Improving EHR use among physicians is an important part of reducing physician burden in the US, which can be done by using scribes, improving EHR training, improving EHR usability, and reducing documentation and billing requirements for providers

Acceptance of Interoperable Electronic Health Record (EHRs) Systems: A Tanzanian e-Health Perspective

The study assessed factors that influence the acceptance of interoperable electronic Health Records (EHRs) Systems in Tanzania Public Hospitals. The study applied a hybrid model that combined the Technology Acceptance Model (TAM) and Technology-Organization-Environment (TOE). Snowball sampling technique was applied and a total of 340 questionnaires were distributed to selected clinics, polyclinics and hospitals, of which 261 (77%) received questionnaires were considered to be valid and reliable for subsequent data analysis. IBM SPSS software version 27.0 was employed for data analysis. Findings indicated that relative advantage, compatibility, management support, organizational competency, training and education, perceived ease of use, perceived usefulness, privacy and security concerns, competitive pressure and regulatory framework have positive and significant effects on acceptance of interoperable EHRs. However, complexity and trading & vendor support were found to have non-significant effects on acceptance of interoperable electronic health records. The study has further provided implications that may assist scholars and policy makers in the implementation of interoperable electronic health systems in the health sector

Personality, top management support, continuance intention to use electronic health record system among nurses in Jordan

Electronic health record system (EHRs) is preferred as standard documentation to track patient information and office visits. It is acclaimed as technological breakthrough capable to improve the healthcare industry’s service delivery and system quality. Accordingly, Jordanian government initiated EHRs implementation in all public hospitals. However, only eleven out of 35 public hospitals have fully implemented EHRs and their usage remains low. Moreover, empirical research associated to the particular concern of EHRs is insufficient and the effort to appraise it is low considering its extensive ongoing implementation. Besides, comprehending and explaining nurses’ continuous intention (CI) to use EHRs are crucial to gauge EHRs usage in Jordan. Considering the problem, this study highlighted on continuous intention (CI) of nurses to use EHRs model by incorporating the following theories; the Unified Theory of Acceptance and Use of Technology (UTAUT), Expectation-Confirmation Theory (ECT) and Five Factor Model (FFM). The model is insinuated to investigate whether UTAUT factors namely effort expectancy, performance expectancy, social influence, facilitating conditions, FFM domains (conscientiousness, extraversion, neuroticism, openness to experience, and agreeableness) and Top Management Support (TMS) predict nurses’ CI to use EHRs. Total responses are 497 nurses. Partial Least Squares technique used for analysis. Results revealed significant positive relationship between UTAUT factors and CI. However, there is no significant evidence of relationship between TMS and CI. The study also disclosed significant mediating influence of performance expectancy on two separate hypotheses concerning two predictors namely agreeableness and openness to experience on CI. Additionally, the study revealed significant moderation impact of conscientiousness on the relationship between both performance expectancy and social influence with CI. The study has illustrated important attention to substantive differences between acceptance and continuance to use behaviors

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

Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Background: The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective: This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods: We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results: Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions: Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research