Adoption of Medication Management Technologies by U.S. Acute Care Hospitals after the HITECH Act

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in the year 2011, is the most important regulation in recent years focused on enhancing the use of IT in the health care system.This study examined the organizational and environmental correlates of the adoption of Medication Management Technologies (MMTs) by U.S. acute care hospitals after the HITECH Act. The rational adaptation perspective of the resource dependence theory is utilized in this study, using panel data from 2009 to 2013 with a one-year lag for independent variables and mixed-effects regression models for analyses. The study operationalized adoption of MMTs through seven measures: global adoption of MMTs, adoption of closed loop medication management, adoption of meaningful use MMTs and adoption-levels for the four steps of the medication management process: ordering, transcribing, dispensing and administration. Hospitals were more likely to adopt MMTs in the time after the implementation of the HITECH Act (2012, 2013) and were less likely to adopt MMTs before the implementation of the HITECH Act (2009, 2010) as compared to the HITECH Act implementation period (2011). The study further found that the resource dependence construct of munificence, operationalized through organizational size, and the construct of interdependence, operationalized through private payer mix was significantly associated with the adoption of MMTs

Improving Computerized Provider Order Entry Usage in a Community Hospital

The healthcare industry is now faced with the balance between instituting computerized technology and providing safe, high quality, efficient, and lower cost patient care. An important aspect of computer technology is the direct entry of orders electronically by providers into the electronic health record, termed computerized provider order entry (CPOE). This translational research project begins by defining CPOE and discussing CPOE’s effect on patient safety and quality of care by reducing preventable medical errors and adverse drug events and CPOE’s effect on healthcare costs. Regulatory requirements pertaining to CPOE are discussed; providers are expected to be proficient in CPOE in order to meet these requirements. A literature review of barriers to CPOE usage, interventions to implement and improve usage of CPOE, and trends in CPOE usage is conducted and discussed. The purpose of this quality improvement project was to improve CPOE medication order usage among providers within a community hospital by utilizing the provider order entry user satisfaction and usage survey (POEUSUS) to identify barriers to the utilization of CPOE and by employing the technology acceptance model (TAM) and the provision of a CPOE facilitator on the patient care units for twelve hours per week for eight weeks. At the conclusion of the eight-week intervention, the CPOE utilization rates were determined and followed over an eight week interval and were compared to pre-intervention rates. Additionally, providers’ rated their satisfaction of the CPOE facilitator by completing a facilitator survey after each assistance session. The results of this project demonstrated an increase in CPOE medication order usage, from 45.4% CPOE medication order usage during the eight-week pre-intervention period to 55.6% CPOE medication order usage during the eight-week post-intervention period. A statistically significant improvement in provider CPOE satisfaction occurred after the intervention, and providers expressed high degrees of satisfaction with the real-time assistance of the CPOE facilitator. Aspects of CPOE admired by providers and recommendations of providers to changes in CPOE were determined. Finally, age was inversely related and previous computer experiment was positively related to CPOE medication order usage pre-intervention, meaning that younger providers and providers with more computer experience used CPOE more often

Predictive Relationships Between Electronic Health Records Attributes and Meaningful Use Objectives

The use of electronic health records (EHR) has the potential to improve relationships between physicians and patients and significantly improve care delivery. The purpose of this study was to analyze the relationships between hospital attributes and EHR implementation. The research design for this study was the cross-sectional approach. Secondary data from the Health Information and Management Systems Society (HIMSS) Analytics Database was utilized (n = 169) in a correlational crosssectional research design. Normalization Process Theory (NPT) and implementation theory were the theoretical underpinnings used in this study. Multiple linear regressions results showed statistically significant relationships between the 4 independent variables (region, ownership status, number of staffed beds [size], and organizational control) and the outcomes for the dependent variables of EHR software application attributes (Clinical Decision Support Systems (CDSS) components), EHR software application attributes (major systems), and successful implementation of Meaningful Use (MU) (p = .001). A statistically significant relationship (p = .001) was also found between the 2 independent variables (EHR software application attributes [CDSS components] and EHR software application attributes [major systems]) and the outcome of successful implementation of MU when combined. This evidence should provide policy makers and health practitioners support for their attempts to implement EHR systems to result in positive Meaningful Use which has been shown to be more cost effective and result in better quality of care for patients.The potential social change is improved medication prescribing and administration for hospitals and, lower cost and better quality of care for patients

A Measurement of Readiness for Tennessee Hospitals to Implement “Meaningful Use” Criteria Resulting from the American Recovery and Reinvestment Act, 2009

In 2009, the American Recovery and Reinvestment Act was signed into law. This legislation provided for monetary rewards for those acute-care hospitals that meet meaningful use computerization and reporting criteria. The study used a descriptive, nonexperimental design to answer three research questions (1) What is the level of readiness to meet meaningful use criteria in the Tennessee Hospital Association (THA) member hospitals; (2) What is the level of readiness to meet meaningful use criteria in the rural THA member hospitals; and (3) Is there a difference in the readiness to meet meaningful use criteria between rural and urban THA member hospitals?. A survey was sent to 115 THA member hospital, with a return rate of 83% (N=95). The inclusion criteria focused on acute-care hospitals, with rehabilitation, psychiatric and long-term care hospitals falling into the exclusion criteria. The Readiness Score was determined for the total survey respondents (N=95), as well as for the rural (N=41) hospitals and urban (N=54) hospitals in the Tennessee Hospital Association member hospitals meeting the inclusion criteria. Z-scores of the readiness score were examined and indicated that there was one outlier with z\u3e3.0. Therefore, that case was removed from the comparison in the t-test (N=94). The t-test comparison of rural and urban hospital found a significant difference at (p=.002), two tailed. To ensure that the slightly nonnormal distribution of the readiness scores did not explain the difference found with the t-test, an additional nonparametric test was also conducted. The Mann Whitney U-test showed that even with the assumption of a normal distribution is not made, the difference in readiness between urban and rural hospitals is still statistically significant at p=0.026

Overcoming challenges to achieving meaningful use: insights from hospitals that successfully received Centers for Medicare and Medicaid Services payments in 2011

Objective In an effort to understand better the federal electronic health record (EHR) incentive programme's challenges, this study compared hospitals that did and did not receive meaningful use (MU) payments in the programme's first year based on the challenges they anticipated a year before. Materials and Methods This cross-sectional study used 2010 American Hospital Association survey data and 2011 Centers for Medicare and Medicaid Services data that identify hospitals receiving MU payments. Multivariate regression analysis assessed differences in 2010 anticipated challenges to MU for hospitals that were successful in earning 2011 MU payment compared to hospitals that intended to participate in the programme but were not yet successful. Results The study sample consisted of 2475 hospitals, 313 of which received MU payments in 2011. Controlling for standard hospital characteristics, hospitals that reported the computerized provider order entry (CPOE) MU criterion as a primary challenge were 18% less likely to receive a 2011 MU payment compared to hospitals that reported other criteria as primary challenges. Discussion CPOE was the main challenge among hospitals that failed to achieve MU in the first year of the programme. In order to maximize the incentive programme's effectiveness, policymakers, healthcare organizations, and EHR vendors may benefit from increased attention to hospitals’ challenges with CPOE. Conclusion As the EHR incentive programme matures, policymakers and other stakeholders should consider strategies that maintain the critical elements of MU while adequately supporting hospitals that desire to become MU but are impeded by specific technological, cultural, and organizational adoption and use challenges

Understanding health information technology adoption: A synthesis of literature from an activity perspective

The vast body of literature on health information technology (HIT) adoption features considerably heterogeneous factors and demands for a synthesis of the knowledge in the field. This study employs text mining and network analysis techniques to identify the important concepts and their relationships in the abstracts of 979 articles of HIT adoption. Through the lens of Activity Theory, the revealed concept map of HIT adoption can be viewed as a complex activity system involving different users, technologies and tasks at both the individual level and the social level. Such a synthesis not only discloses the current knowledge domain of HIT adoption, but also provides guidance for future research on HIT adoption

Adoption of Electronic Health Records by Admitting Physicians: A Heuristic Model

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption. Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical specialty; high volume; hospital-based; high inpatient ratio; and high loyalty. Methods: Administrative data collected for 326 physicians admitting at least ten patients during the six months following EHR activation represented over 80% of the total admissions. Logistic Regression and Cox Regression were used to evaluate how well variables predicted adoption (80% utilization) and adoption rate. Results: The Logistic Regression model predicted significant proportions of variation in adoption of CPOE (66%), EH&P (34%) and EDS (40%). CPOE adoption was more likely (p \u3c .05) for physicians who were male, had a high inpatient ratio, lower patient volume and community hospital setting. EH&P and EDS adoption was more likely for physicians with financial alignment and large, academic hospital setting. The Cox Regression model predicted significant proportions of variation in rate of adoption of CPOE (10%), EH&P (14%) and EDS (19%). The overall model for CPOE was significant (p=.006); no individual predictors were significant. Physicians who were financially aligned or worked at the large, academic hospital adopted EH&P and EDS faster. Conclusion: Personal factors: loyalty, age and gender were generally not predictive. Organizational factors: hospital setting and financial alignment were most predictive of adoption. Study results may help administrators improve EHR installations

Association of Electronic Health Records with Methicillin-Resistant Staphylococcus aureus Infection in a National Sample

This study examined the relationship between advanced electronic health record (EHR) use in hospitals and rates of Methicillin-resistant Staphylococcus aureus (MRSA) infection in an inpatient setting. National Inpatient Sample (NIS) and Health Information Management Systems Society (HIMSS) Annual Survey are combined in the retrospective, cross-sectional analysis. A twenty percent simple random sample of the combined 2009 NIS and HIMSS datasets included a total of 1,032,905 patient cases of MRSA in 550 hospitals. Results of the propensity-adjusted logistic regression model revealed a statistically significant association between advanced EHR and MRSA, with patient cases from an advanced EHR being less likely to report a MRSA diagnosis code