Which electronic health record system should we use? A systematic review

The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE's eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE's eight characteristics for software evaluation

Exploring the Emergence of Open Platforms in Healthcare: Design Considerations and Experiences from an Initial Case in Norwegian Primary Care

Despite significant efforts on improving interoperability of health information and lowering socio-technical cost of replacing clinical applications, healthcare organizations and professionals struggle with fragmented and non-interoperable Health Information Technologies. This paper describes the emergence of open platforms, which may alleviate challenges related to interoperability issues, weak integrations, siloed data repositories, and numerous legacy systems within healthcare. Using a proposed platform initiative in Norway, we explore the open platform phenomenon with a socio-technical lens, and highlights four key topics that have produced tension and merits consideration from the involved stakeholders: i) Procurement strategy and vendor neutrality, ii) Ability to facilitate flexible use, iii) The use of standards and separation of data and application, and iv) Strategies for development and governance of standards. We further discuss the related implications and design considerations necessary to support complex patient pathways and provide clinicians more flexible and effective systems

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

Objective: To review the developments in human factors (HF)research on the challenges of health information technology(HIT) implementation and impact given the continuing incidenceof usability problems and unintended consequences from HITdevelopment and use.Methods: A search of PubMed/Medline and Web of Science®identified HF research published in 2015 and 2016. Electronichealth records (EHRs) and patient-centred HIT emerged assignificant foci of recent HF research. The authors selected prominentpapers highlighting ongoing HF and usability challenges inthese areas. This selective rather than systematic review of recentHF research highlights these key challenges and reflects on theirimplications on the future impact of HF research on HIT.Results: Research provides evidence of continued poor design,implementation, and usability of HIT, as well as technologyinducederrors and unintended consequences. The paperhighlights support for: (i) strengthening the evidence base on thebenefits of HF approaches; (ii) improving knowledge translationin the implementation of HF approaches during HIT design,implementation, and evaluation; (iii) increasing transparency,governance, and enforcement of HF best practices at all stages ofthe HIT system development life cycle.Discussion and Conclusion: HF and usability approaches are yetto become embedded as integral components of HIT development,implementation, and impact assessment. As HIT becomesever-more pervasive including with patients as end-users, thereis a need to expand our conceptualisation of the problems to beaddressed and the suite of tactics and strategies to be used tocalibrate our pro-active involvement in its improvement

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

Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems

Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter\u27s (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees\u27 concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter\u27s eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients\u27 families and communities through reducing the costs of healthcare

Send Us the Bitcoin or Patients Will Die: Addressing the Risks of Ransomware Attacks on Hospitals

Part I of this Article describes how the healthcare industry has arrived in this place of vulnerability, including (1) the history of the movement toward EHRs through HIPAA, (2) HIPAA’s meaningful use regulations and the background of current ransomware attacks, and (3) the distinctions between these attacks and other security breaches that have plagued large insurers and health systems within the last five years. Next, Part II will examine current industry culture when it comes to cybersecurity and review current legal and business approaches to address this growing threat. Then, Part III will argue that, while the current laws—including HIPAA and HITECH—are a good start, they do not go far enough to curb the current ransomware attacks and thus, should be amended. It will further argue that such amendments cannot be the only solution. Rather, the healthcare industry has to spur its own movement toward better and tighter security over its healthcare technology. Lastly, this Article will conclude with some suggestions and recommendations for how industry and government regulators can work together to assure that hospitals and health systems are not faced with the dilemma of having to choose between patient safety and the payment of a bitcoin ransom

What are the Gaps in Mobile Patient Portal? Mining Users Feedback Using Topic Modeling

Patient portals are positioned as a central component of patient engagement through the potential to change the physician-patient relationship and enable chronic disease self-management. In this article, we extend the existing literature by discovering design gaps for patient portals from a systematic analysis of negative users’ feedback from the actual use of patient portals. Specifically, we adopt topic modeling approach, LDA algorithm, to discover design gaps from online low rating user reviews of a common mobile patient portal, EPIC’s mychart. To validate the extracted gaps, we compared the results of LDA analysis with that of human analysis. Overall, the results revealed opportunities to improve collaboration and to enhance the design of portals intended for patient-centered care

A Systematic Analysis of Patient Portals Adoption, Acceptance and Usage: The Trajectory for Triple Aim?

Personal Health Records (PHR), often known as patient portal, are consumer-centric tools that can strengthen consumers’ ability to actively manage their own health and healthcare. The incorporation of patient portals provides the promise to assist with Triple Aim and population health goals. Patient portals encourage patients to play a more active role in their healthcare by giving them more responsibility for maintaining a healthy lifestyle and managing chronic diseases and thus may provide a cost-effective way to improve quality of care. In this study, we extend the existing literature by using a data analytic approach to provide more insights in adopting mobile patient portals. Specifically, we aim to use topic modeling approach, LDA algorithm, to systematically analyze users’ feedback (i.e., online users’ reviews) from the actual use of a common mobile patient portal, Epic’s MyChart. To validate the extracted topics, we compared the results of LDA analysis with that of human analysis. Overall, the extracted topics revealed opportunities for improvement and to enhance the design of current basic portals to improve usage. Improved portal usage will move toward effective population health management and achievement of the triple aim goals

Improving Antibiotic Resistant Infection Transmission Situational Awareness in Enclosed Facilities with a Novel Graphical User Interface for Tactical Biosurveillance

Serious challenges associated with antibiotic resistant infections (ABRIs) force healthcare practitioners (HCP) to seek innovative approaches that will slow the emergence of new ABRIs and prevent their spread. It was realized that traditional approaches to infection prevention based on education, retrospective reports, and biosurveillance often fail to ensure reliable compliance with infection prevention guidelines and real-time problem solving. The objective of this original research was to develop and test the conceptual design of a situational awareness (SA)-oriented information system for coping with healthcare-associated infection transmission. Constantly changing patterns in spatial distribution of patients, prevalence of infectious cases, clustering of contacts, and frequency of contacts may compromise the effectiveness of infection prevention and control in hospitals. It was hypothesized that providing HCPs with a graphical user interface (GUI) to visualize spatial information on the risks of exposure to ABRIs would effectively increase HCPs’ SA. Increased SA may enhance biosurveillance and result in tactical decisions leading to better patient outcomes. The study employed a mixed qualitative-quantitative research method encompassing conceptualization of GUI content, transcription of electronic health record and biosurveillance data into GUI visual artifacts, and evaluation of the GUI’s impact on HCPs’ perception and comprehension of the conditions that increase the risk of ABRI transmission. The study provided pilot evidence that visualization of spatial disease distribution and spatially-linked exposures and interventions significantly increases HCPs’ SA when compared to current practice. The research demonstrates that the SA-oriented GUI enables the HCPs to promptly answer the question, “At a given location, what are the risks of infection transmission there?” This research provides a new form of medical knowledge representation for spatial population-based decision-making within enclosed environments. The next steps include rapid application development and further hypothesis testing concerning the impact of this GUI on decsion-making