Multi-level analysis of electronic health record adoption by health care professionals: A study protocol

<p>Abstract</p> <p>Background</p> <p>The electronic health record (EHR) is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors.</p> <p>Methods</p> <p>A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada). At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary.</p> <p>Results</p> <p>The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings.</p> <p>Conclusions</p> <p>These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition, this research constitutes a major contribution to the field of knowledge transfer and implementation science.</p

Resolving stakeholder tussles in healthcare systems: ethical challenges to data protection

For cross-border collaborative healthcare delivery, data protection legislation seems to be increasingly obstructive. In extreme cases, this may compromise the quality of care a patient receives and at the same time prevent clinicians practicing and developing their medical skills to their full potential. A dilemma develops whereby the fundamental rights of patient and clinician are constrained by the very legal instruments designed to make delivery of healthcare easier. The contention between patient and clinician expectations, or tussles, may pose a threat to future healthcare delivery. Compromising healthcare delivery in this way has wider implications for community trust. The concept of tussles in technology infrastructures suggests an actor-network approach involving the patient and clinician relationship within the context of community response to their interactions to offer an innovative perspective on the problem of tussles in healthcare. In this paper, we develop such an approach and discuss an initial validation based on cross-border healthcare scenarios illustrating the contention between fundamental ethical rights and actor-network compliance