Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

We are bitter, but we are better off: Case study of the implementation of an electronic health record system into a mental health hospital in England

In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders' experiences and the local consequences of the implementation of an EHR system into a mental health hospital

Acceptance model of electronic medical record

This paper discusses acceptance issues of Electronic Medical Record System (EMR), particularly in Malaysia. A detailed overview of EMR and its benefits are firstly discussed. A number of acceptance models are scrutinized. Then factors affecting EMR acceptance are put forward. Finally, before proposing an EMR acceptance model, an instrument formed by adapting and then finding its factors loading is presented

Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method

Background: The extensive and rapidly expanding research literature on electronic patient records (EPRs) presents challenges to systematic reviewers. This literature is heterogeneous and at times conflicting, not least because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches. Aim: To map, interpret and critique the range of concepts, theories, methods and empirical findings on EPRs, with a particular emphasis on the implementation and use of EPR systems. Method: Using the meta-narrative method of systematic review, and applying search strategies that took us beyond the Medline-indexed literature, we identified over 500 full-text sources. We used ‘conflicting’ findings to address higher-order questions about how the EPR and its implementation were differently conceptualised and studied by different communities of researchers. Main findings: Our final synthesis included 24 previous systematic reviews and 94 additional primary studies, most of the latter from outside the biomedical literature. A number of tensions were evident, particularly in relation to: [1] the EPR (‘container’ or ‘itinerary’); [2] the EPR user (‘information-processer’ or ‘member of socio-technical network’); [3] organizational context (‘the setting within which the EPR is implemented’ or ‘the EPR-in-use’); [4] clinical work (‘decision-making’ or ‘situated practice’); [5] the process of change (‘the logic of determinism’ or ‘the logic of opposition’); [6] implementation success (‘objectively defined’ or ‘socially negotiated’); and [7] complexity and scale (‘the bigger the better’ or ‘small is beautiful’). Findings suggest that integration of EPRs will always require human work to re-contextualize knowledge for different uses; that whilst secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work may be made less efficient; that paper, far from being technologically obsolete, currently offers greater ecological flexibility than most forms of electronic record; and that smaller systems may sometimes be more efficient and effective than larger ones. Conclusions: The tensions and paradoxes revealed in this study extend and challenge previous reviews and suggest that the evidence base for some EPR programs is more limited than is often assumed. We offer this paper as a preliminary contribution to a much-needed debate on this evidence and its implications, and suggest avenues for new research

Perspectives of Primary Care Physicians on Adopting Electronic Medical Records in the Atlanta, Georgia Area

Slow adoption of electronic medical records (EMR) by primary care physicians in medical office practices has not facilitated the EMR adoption process. The problem is the slow pace of EMR adoption by primary care physicians in the Atlanta, Georgia area has become a public health concern. Research regarding the lived experiences of these physicians with EMR implementation and utilization may identify reasons for the slow adoption. The purpose of this phenomenological study was to explore the lived experiences of primary care physicians, who practice in the Atlanta area, regarding their perception, successes, barriers, and urgency of adoption of EMR in their healthcare practice. Lewin\u27s change management model of health services served as the framework for the study. Data was collected during face-to-face interviews with 19 primary care physicians at Grady\u27s Ponce de Leon Clinic and Grady\u27s East Point Clinic in Atlanta, Georgia. Participants were physicians or residents and not those in authority to make decisions about the EMR at the two clinics. NVivo 10 and automatic coding was used for data analysis to develop themes from the interviews. The findings revealed that the adoption of EMR has enabled primary care physicians to spend more time with their patients, but the barriers such as a lack of interoperability and lack of training, has fostered a feeling of disinterestedness towards EMR adoption. This study supports positive social change that EMR adoption aids in improving patient safety and outcome

Back to the future of IT adoption and evaluation in healthcare

This is a time of expansion, hope and change in the area of Health Information Technology (HIT). In this study, we provide an in-depth perspective into the adoption and diffusion of IT in healthcare based on a review of the current literature and upon expert panel assessments of adoption and diffusion issues, achievements to date, challenges facing key e-health technologies and future possibilities. These data are synthesised in the form of a research framework showing the main three areas of e-health (Electronic Medical Records, Clinical and Administrative systems and Telehealth) on three levels (individual, organisation and system). Current adoption and diffusion challenges and future possibilities are systematically presented via this research framework to inspire practice and research with both an individual and collective view of the key health systems currently confronting the healthcare sector

Defining and Measuring the Patient-Centered Medical Home

The patient-centered medical home (PCMH) is four things: 1) the fundamental tenets of primary care: first contact access, comprehensiveness, integration/coordination, and relationships involving sustained partnership; 2) new ways of organizing practice; 3) development of practices’ internal capabilities, and 4) related health care system and reimbursement changes. All of these are focused on improving the health of whole people, families, communities and populations, and on increasing the value of healthcare

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