Users’ satisfaction with the primary health care information system in Croatia: a cross-sectional study

AIM: To evaluate the primary health care information system from the general practitioner's (GP) point of view. ----- METHODS: Sixty-seven Croatian GPs were distributed a questionnaire about characteristics of the GP's office, overall impression of the application, handling of daily routine information, more sophisticated information needs, and data security, and rated their satisfaction with each component from 1 to 5. We also compared two most frequently used applications--application with distantly installed software (DIS) and that with locally installed software (LIS, personal computer-based application). ----- RESULTS: GPs were most satisfied with the daily procedures and the reminder component of the health information system (rating 4.1). The overall impression ranked second (3.5) and flexibility of applications followed closely (3.4). The most questionable aspect of applications was data security (3.0). LIS system received better overall rate than DIS (4.2 vs 3.2). ----- CONCLUSION: Applications received better ratings for daily routine use than for overall impression and ability to get specific information according the GPs' needs. Poor ratings on the capability of the application, complaints about unreliable links, and doubts about data security point to a need for more user-friendly interfaces, more information on the capability of the application, and a valid certificate of assessment for every application

Impact of electronic medical record on physician practice in office settings: a systematic review

<p>Abstract</p> <p>Background</p> <p>Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.</p> <p>Results</p> <p>For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.</p> <p>In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.</p> <p>Conclusions</p> <p>Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.</p

What to expect from electronic patient record system implementation; lessons learned from published evidence

Background: Numerous studies have examined specific factors related to success, failure and implications of Electronic patient record (EPR) system implementations, but usually limited to specific aspects.  Objective: To review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.Method: Literature reviewResults: 312 potential articles were identified on initial search of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation, and screening performance, and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.Conclusion: The findings presented here represent synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system

A COMPREHENSIVE MODEL TO EXPLAINING USERS’ ACCEPTANCE AND INTENTION TO USE ELECTRONIC HEALTH RECORDS(EHR)IN REHABILITATION FACILITIES IN SAUDI ARABIA

This study provided a literature-based model that was developed by using a general and cumulative approach to explain user attitudes toward EHR. The model embodies the Theory of Reasoned Action (TRA), the Technology Acceptance Model (TAM), and the barriers that hinder users from proper use of the EHR system. Dimensions related to Human, Technological, Organizational, Professional, Legal, and Financial sources of influence were identified and tested in a special care setting. Because rehabilitation care facilities require an interdisciplinary (interactive) and multidisciplinary (additive) care approach, they pose an extra challenge. The current situation of the Saudi healthcare system demands a transition to a more connected and integrated system among different facilities of a single provider and across different providers. This situation underscores the need to have EHR in place and demands that particular attention be paid to user acceptance of the system. Thus, current and potential users of EHR in Saudi Arabia were targeted and asked to rate the importance of each source of influence on their attitudes toward EHR. The sample size was 319, comprising respondents from more than 20 hospitals and rehabilitation care facilities, and 263 responses were eligible for statistical analysis. Examining the model revealed that human, technological, organizational, and professional dimensions are the necessary and sufficient predictors for users in the tested settings. This calls for raising awareness of EHR and its anticipated benefits and difficulties. Continuous learning and ongoing training sessions are key aspects in attaining users’ acceptance of EHR. The findings of this study also call for developing policies and legal procedures to regulate the use of EHR in Saudi Arabia by establishing a national regulator and enforcement bodies to oversee issues related to system security and patient privacy. Furthermore, it is worth proposing an act or policy (stimuli) to promote the adoption and meaningful use of EHR and to keep costs of EHR low, especially for the private sector. Regarding future directions, the proposed model is to be taken to different levels and examined in different care settings, geographic areas, and with different technologies, including but not limited to mHealth, cloud computing, and telehealth

Issues Concerning the Adoption and Usage of Electronic Medical Records in Ministry of Health Hospitals in Saudi Arabia

Abstract Background:There is a lack of research with regard to understanding the factors that motivate hospitals to proceed with implementing Electronic Medical Record Systems (EMR). The Health Information Management and System Society (HIMSS) outlines eight levels of EMR implementation from 0(no implementation) to 7(full use and implementation of the system). Some hospitals proceed to implement EMR and achieve a high level of implementation, while others stop at a certain level of EMR implementation or may even regress to lower levels. Aims and Methods: This research aimed to develop a framework to understand the motivational and de-motivational factors for proceeding with EMR implementationto uncover which hospitals have implemented EMR, to which levels, and how hospitals perceive EMR. In order to accomplish this,a mixed method design was adopted including a survey and case studies of a sample of hospitals in Eastern Saudi Arabia. The three case study sites were: a large hospital located in the capital city, a medium hospital located in a town, and a small hospital located in an isolated rural area. Results: The study found that 3 out of 29 hospitals in the area had implemented EMR. Contrary to expectations, the largest hospital located in the central city had regressed from level four of EMR implementation to level one, whereas the smallest hospital located in anisolated rural location achieved the highest EMR level. It was found that there were common factors that affected all the case study sites, whileother factors varied among them. Shared factors motivating sites to adopt EMR included a desire to escape from the manual system, whereas shared de-motivational factors included funding and technical problems. As these factors were common across sites at different levels of implementation, it is suggested that they do not sufficiently explain the variance in implementation level. It is argued that factors which varied between sites, however, may shed more light on the main motivators for implementation. For example, although there were technical problems across the sites,the way these technical problems were treated made the difference in terms of the success of the implementation. Additionally, top management commitment, users’ involvement in the EMR development and other factors varying between sites appeared to make the difference in the implementation’s success. Conclusion:The study concluded that all these common and varied factors affectedstaff attitudes toward the system. However, the site-related factors were perceived to be the main driver for the variance in the implementations. Since all site-related factors are controllable by top management, it is recommended that EMR implementation should be managed and supervised by a committee consisting of representatives from among clinical staff and IT staff. Based on this research, it is believed that such a committee is necessary for proceeding with an EMR implementation. However, there is no empirical evidence from this research about that. Therefore, it is advised that future research should find the rules, authorities and compositions of such committees that would make the committee effective

A strategic roadmap for achieving the potential benefits of electronic health record system in the state of Kuwait

This research investigates the desired benefits of using an Electronic Health Record (EHR) in Kuwait Primary Health Care Centers and the perceived barriers to its successful adoption. From this, a set of key strategic capabilities are proposed, ranked for priority and urgency as a roadmap for EHR adoption in the State of Kuwait. This thesis examines the organization of the health care system in Kuwait and important issues related to primary health care, including the implementation and current use of the EHR system at Kuwait primary health care centers. International evidence of the EHR system benefits, barriers and capabilities such as interoperability, confidentiality and security were used as the basis for user surveys. The research applied domain theory and research-based improvement strategy as a means of identifying the stakeholders and the priorities area of investigation. The research utilized a quantitative research design focusing on multiple case studies as the survey methodology. Two case study surveys were conducted to identify the main benefits and barriers that affect the adoption of the EHR at international and national (Kuwaiti) levels. The first survey involved international and national decision makers. The second survey involved healthcare professionals working in Kuwait primary health care to assess their view regarding the features of the current system, the benefits and barriers of more complete EHRs. The results of first and second surveys were used to develop a list of key EHR system capabilities and adoption requirements relevant to Kuwait primary care. This list was used for the design of a third survey, for senior stakeholders at the Kuwait Ministry of Health, to identify their strategic roadmap priorities. This research, drawing on the literature of the EHR design and implementation, a study of international initiatives of the EHR adoption and outputs of three case studies, has emphasized the importance of developing a strategic roadmap for Kuwait to achieve the potential benefits of EHRs