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

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

Critical Issues in EHR Implementation: Provider and Vendor Perspectives

Stakeholders, both internal and external, can have differing and sometimes conflicting perspectives and priorities even though each has a vested interest in organizational success. Using the lens of stakeholder theory, we examine the differing views of stakeholders (namely, medical providers and vendors) in the implementation of electronic health record (EHR) systems. The implementation process itself can be broken down into three phases: pre-implementation, during implementation, and post-implementation. After determining a comprehensive set of seventeen key issues relevant to each phase, we discovered that there are significant differences in the perceptions of EHR vendors and their customers in terms of which issues in each phase of an EHR implementation are most important. These findings indicate that vendors tend to underestimate the role of nursing staff and that providers tend to underestimate the role of security. Both groups, however, agree that physician support throughout the implementation is essential for success

Physicians’ Perceptions of Facilitators and Barriers in Electronic Health Record Education

A significant focus in health care is quality documentation to lower patient safety risks. The local problem at a healthcare organization in the northeastern United States is that some physicians are falling short with quality documentation of patient care in athenaNet, a cloud-based electronic health record (EHR). This qualitative case study was conducted to explore physicians\u27 perceptions of the facilitators and barriers that impact the educational process for quality documentation in EHRs. Attention also focused on identifying physicians\u27 recommendations for enhancing the educational process for quality documentation. Knowles’ adult learning theory served as the conceptual framework. Purposeful sampling was used to select participants who had a minimum of 5 years’ experience as a physician and had worked with multiple EHRs in the past. Individual interviews with 11 physicians were supplemented with review of documents in athenaNet on milestones in physician documentation. Data analysis included coding of interview transcripts and information from documents to identify common themes: (a) preparation for implementation, (b) specialty-specific training, (c) hands-on practice, (d) time limitations on completing training, (e) preparedness for EHR go-live, and (f) additional training resources. Findings of the study were used to develop a white paper to increase the quality of the documentation entered into an EHR, and to lower patient safety risks through more effective continuing education. The study contributes to positive social change through modifications to the current training methodology for the EHR as a solution to assisting physicians to complete quality documentation

Detailed Perceptions by Health Service Providers Around EHRs: A Case Study of Australia’s e-Health Solution

The Australian government has invested heavily in the national e-health solution; namely, initially, the PCEHR, now MyHealth Record. A critical success factor is concerned with the perception and expectations of health service providers regarding the MyHealth Record. Further, it is important to understand the effect of the MyHealth Record on the patient-provider relationship, quality of care, and service providers’ views toward data security and confidentiality. The primary goal of this pilot study is to understand the health service providers’ perceptions and expectations; and thereby, predict the likely sustainability of the MyHealth Record. This has important implications in general as all OECD countries’ transition to large-scale e-health solutions

Implementing electronic health records in hospitals:a systematic literature review

Background: The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers. Methods: A systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria. Results: Of the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process. Conclusions: Although EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies for hospitals

Program Evaluation of a Bundled Educational Intervention to Enhance Implementation of Professional Exchange Report

Communication handover is a source of potential error and risk to patient safety. Electronic-based tools may reduce errors and mitigate risks to patient safety. Electronic tools have been successfully implemented using multiple methods of education and training. Electronic tools vary in functionality and integration with the electronic health record (EHR). A large West Michigan Regional Health System (RHS) implemented a new EHR containing an embedded tool for communication handover called Professional Exchange Report (PER). There was inconsistency in the practice of bedside report by nurses. The RHS planned to use a bundled approach of educational interventions to implement the new tool and report structure including communications, video demonstration, in-seat training and at the elbow support during the go-live. This project systematically evaluated the interventions to implement PER using evidence based methodology. Evaluation was based on collection of data and evidence through interviews, pre- and post-implementation surveys, observations of the report process, and review of documents related to planning, implementing and evaluating the program. Organizational leaders engaged in robust planning. Educational interventions were evidence-based. Implementation was carried out effectively. The organization did not have a detailed, specific plan for evaluation of educational interventions or PER outcomes. Change in length of report could not be attributed to the process change, and nurse perceptions of the process and consistency of practice at bedside did not change. Observed opening of the EHR during report increased by 68%. There were statistically significant increases in yes responses to awareness of, understanding why, knowledge of specific, and ability to make practice changes

National Digital Infrastructure and India’s Healthcare Sector: Physician’s Perspectives

Patient-centric digital infrastructure can potentially enhance the efficiency of healthcare systems. However, even in developed nations, evidence suggests low adoption rates for such infrastructure and lack of support from clinicians is considered as one of the most critical hindering factors. In this study, we examine physicians\u27 perceptions of the proposed large-scale information technology initiative in India that aims to transform the health sector and provide universal health coverage to all residents of India. We employed the information ecology lens to understand the broader changes in the healthcare system that could result from the initiative. We use focus group discussion and in-depth interviews to comprehend the perceptions of doctors about the initiative. Drawing upon Foucault’s conceptualization of power, we find that physicians, the key stakeholders in this initiative, are skeptical about the changes in the locus of power in the new ecosystem. Specifically, they perceive that knowledge power has shifted from a historical “expert knowledge power” to power related to “data management.” The physicians believe that changes are expected to manifest through monitoring, controlling, and managing the data rather than providing knowledge-based services. We present recommendations to engage physicians\u27 perspectives in implementing large-scale patient-centric digital infrastructure

The Economics of Information Technology in Public Sector Health Facilities in Developing Countries: The Case of South Africa

The public healthcare sector in developing countries face many challenges, including weak healthcare systems and under resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Healthcare delivery, access to healthcare and cost containment has the potential for improvement through more efficient healthcare resource management. Global references demonstrate that information technology (IT) has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of new systems implementations on service delivery, user adoption and organizational culture within the hospital setting in South Africa, as perceived by doctors, nurses and hospital administrators. The research provides some insight into the reasons for investing in system automation, the associated outcomes, and organiztional factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation.Hospital information systems; healthcare management; electronic health records; South Africa, mixed methods