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Rahimi B, Karimian S, Ghaznavi A, Jafari Heydarlou M. Requirements specification, design, and evaluation of dental image exchange and management system with user-centered approach: A case study in Iran. Health Sci Rep 2023; 6:e1760. [PMID: 38111743 PMCID: PMC10725998 DOI: 10.1002/hsr2.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 12/20/2023] Open
Abstract
Background and Aims Systems existing in hospital or clinic settings offer services within the physical environment. Examples of such systems include picture archiving and communication systems, which provide remote services for patients. To develop a successful system, methods like software development life cycles (SDLCs) and design techniques, such as prototyping, are needed. This study aimed to specify requirements, design, and evaluation of dental image exchange and management system using a user-centered approach. Methods This cross-sectional study was conducted in four phases, each corresponding to different stages of SDLCs. User-needs data were used to gathered by interviews and observations. A prototype was developed using object-oriented programming and presented to users for feedback. Finally, focus group was used to finalized the prototype into the desired system. Results User needs were identified and prioritized from the outset, with ease of use, security, and mobile apps being their most essential requirements. The prototype underwent several iterations of design and evaluation in focus group sessions until users were satisfied, and their feedback was incorporated. Eventually, the prototype was refined into the final system with users' consent. Conclusion The study revealed that instant access to information, voluntary participation, user interface (UI) design, and usefulness were critical variables for users and should be integral to any system. Successful implementation of such a system requires careful consideration of end-users' needs and their application to the system. Moreover, integrating the system with electronic health records can further enhance the treatment process and the efficiency of medical staff. The voluntary perspective of users played a significant role in achieving an exemplary UI and overall satisfaction with the system. Developers and policymakers should consider these aspects in similar system development projects.
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Affiliation(s)
- Bahlol Rahimi
- Health and Biomedical Informatics Research CenterUrmia University of Medical SciencesUrmiaIran
| | - Sajjad Karimian
- Student Research CommitteeUrmia University of Medical SciencesUrmiaIran
| | - Aisan Ghaznavi
- Department of Oral and Maxillofacial Radiology, School of DentistryUrmia University of Medical SciencesUrmiaIran
| | - Mohammad Jafari Heydarlou
- Department of Oral and Maxillofacial Disease, School of DentistryUrmia University of Medical SciencesUrmiaIran
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Meri A, Hasan MK, Dauwed M, Jarrar M, Aldujaili A, Al-Bsheish M, Shehab S, Kareem HM. Organizational and behavioral attributes' roles in adopting cloud services: An empirical study in the healthcare industry. PLoS One 2023; 18:e0290654. [PMID: 37624836 PMCID: PMC10456173 DOI: 10.1371/journal.pone.0290654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The need for cloud services has been raised globally to provide a platform for healthcare providers to efficiently manage their citizens' health records and thus provide treatment remotely. In Iraq, the healthcare records of public hospitals are increasing progressively with poor digital management. While recent works indicate cloud computing as a platform for all sectors globally, a lack of empirical evidence demands a comprehensive investigation to identify the significant factors that influence the utilization of cloud health computing. Here we provide a cost-effective, modular, and computationally efficient model of utilizing cloud computing based on the organization theory and the theory of reasoned action perspectives. A total of 105 key informant data were further analyzed. The partial least square structural equation modeling was used for data analysis to explore the effect of organizational structure variables on healthcare information technicians' behaviors to utilize cloud services. Empirical results revealed that Internet networks, software modularity, hardware modularity, and training availability significantly influence information technicians' behavioral control and confirmation. Furthermore, these factors positively impacted their utilization of cloud systems, while behavioral control had no significant effect. The importance-performance map analysis further confirms that these factors exhibit high importance in shaping user utilization. Our findings can provide a comprehensive and unified guide to policymakers in the healthcare industry by focusing on the significant factors in organizational and behavioral contexts to engage health information technicians in the development and implementation phases.
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Affiliation(s)
- Ahmed Meri
- Department of Medical Instrumentation Techniques Engineering, Al-Hussain University College, Karbala, Iraq
| | - Mohammad Khatim Hasan
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohammed Dauwed
- Computer Science, College of Science, University of Baghdad, Baghdad, Iraq
| | - Mu’taman Jarrar
- Vice Deanship for Development and Community Partnership, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Ali Aldujaili
- Department Affairs of Student Accommodation, University of Baghdad, Baghdad, Iraq
- Department of Signal Theory and Communications, Information and Communication Technologies, University of Alcalá, Madrid, Spain
| | - Mohammed Al-Bsheish
- Health Management Department, Batterjee Medical College (PMC), Jeddah, Saudi Arabia
- Al-Nadeem Governmental Hospital, Ministry of Health, Amman, Jordan
| | - Salah Shehab
- College of Graduate Studies, Universiti Tenaga Nasional, Kajang, Selangor, Malaysia
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Benoit B, Frédéric B, Jean-Charles D. Current state of dental informatics in the field of health information systems: a scoping review. BMC Oral Health 2022; 22:131. [PMID: 35439988 PMCID: PMC9020044 DOI: 10.1186/s12903-022-02163-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over the past 50 years, dental informatics has developed significantly in the field of health information systems. Accordingly, several studies have been conducted on standardized clinical coding systems, data capture, and clinical data reuse in dentistry. Methods Based on the definition of health information systems, the literature search was divided into three specific sub-searches: “standardized clinical coding systems,” “data capture,” and “reuse of routine patient care data.” PubMed and Web of Science were searched for peer-reviewed articles. The review was conducted following the PRISMA-ScR protocol. Results A total of 44 articles were identified for inclusion in the review. Of these, 15 were related to “standardized clinical coding systems,” 15 to “data capture,” and 14 to “reuse of routine patient care data.” Articles related to standardized clinical coding systems focused on the design and/or development of proposed systems, on their evaluation and validation, on their adoption in academic settings, and on user perception. Articles related to data capture addressed the issue of data completeness, evaluated user interfaces and workflow integration, and proposed technical solutions. Finally, articles related to reuse of routine patient care data focused on clinical decision support systems centered on patient care, institutional or population-based health monitoring support systems, and clinical research. Conclusions While the development of health information systems, and especially standardized clinical coding systems, has led to significant progress in research and quality measures, most reviewed articles were published in the US. Clinical decision support systems that reuse EDR data have been little studied. Likewise, few studies have examined the working environment of dental practitioners or the pedagogical value of using health information systems in dentistry. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02163-9.
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Affiliation(s)
- Ballester Benoit
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France. .,Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Bukiet Frédéric
- Pôle d'Odontologie, Assistance Publique des Hôpitaux de Marseille, Marseille, France.,Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Dufour Jean-Charles
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.,APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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McInerney C, McCrorie C, Benn J, Habli I, Lawton T, Mebrahtu TF, Randell R, Sheikh N, Johnson O. Evaluating the safety and patient impacts of an artificial intelligence command centre in acute hospital care: a mixed-methods protocol. BMJ Open 2022; 12:e054090. [PMID: 35232784 PMCID: PMC8889317 DOI: 10.1136/bmjopen-2021-054090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This paper presents a mixed-methods study protocol that will be used to evaluate a recent implementation of a real-time, centralised hospital command centre in the UK. The command centre represents a complex intervention within a complex adaptive system. It could support better operational decision-making and facilitate identification and mitigation of threats to patient safety. There is, however, limited research on the impact of such complex health information technology on patient safety, reliability and operational efficiency of healthcare delivery and this study aims to help address that gap. METHODS AND ANALYSIS We will conduct a longitudinal mixed-method evaluation that will be informed by public-and-patient involvement and engagement. Interviews and ethnographic observations will inform iterations with quantitative analysis that will sensitise further qualitative work. Quantitative work will take an iterative approach to identify relevant outcome measures from both the literature and pragmatically from datasets of routinely collected electronic health records. ETHICS AND DISSEMINATION This protocol has been approved by the University of Leeds Engineering and Physical Sciences Research Ethics Committee (#MEEC 20-016) and the National Health Service Health Research Authority (IRAS No.: 285933). Our results will be communicated through peer-reviewed publications in international journals and conferences. We will provide ongoing feedback as part of our engagement work with local trust stakeholders.
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Affiliation(s)
- Ciarán McInerney
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Carolyn McCrorie
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- School of Psychology, University of Leeds Faculty of Social Sciences, Leeds, UK
| | - Jonathan Benn
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- School of Psychology, University of Leeds Faculty of Social Sciences, Leeds, UK
| | - Ibrahim Habli
- Department of Computer Science, University of York, York, UK
| | - Tom Lawton
- Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Teumzghi F Mebrahtu
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
| | - Rebecca Randell
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
- Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Naeem Sheikh
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
| | - Owen Johnson
- School of Computing, University of Leeds Faculty of Engineering and Physical Sciences, Leeds, UK
- Bradford Royal Infirmary, Wolfson Centre for Applied Health Research, Bradford, UK
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Mousavi SM, Takian A, Tara M. Sixteen years of eHealth experiences in Iran: a qualitative content analysis of national policies. Health Res Policy Syst 2021; 19:146. [PMID: 34895250 PMCID: PMC8665305 DOI: 10.1186/s12961-021-00795-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION As a building block of all health systems and a multi-sectoral domain, eHealth has a critical role to accelerate the achievement of sustainable development goals (SDGs), particularly universal health coverage (UHC). Our objective was to provide a better understanding of the recent experiences on eHealth policy, particularly in framing process of the policies and strategies, in an attempt to develop evidence-based recommendations that can inform future eHealth policy formulation, implementation, and development in Iran. METHODS We undertook an exploratory, descriptive, comparative, retrospective and longitudinal analysis of eHealth policies by using content analysis of upstream and other key national policy documents, guided by criteria for reporting qualitative research (COREQ). A systematic and purposive search was conducted to identify publicly-accessible documents related to eHealth policies in Iran, followed by in-depth, semi-structured, open-ended interviews with purposefully identified national key informants in the field of eHealth. MAXQDA® 12 was used to assist with qualitative data analysis. FINDINGS We retrieved and included 13 national policy documents demonstrating 16 years experiences of recorded eHealth policy in Iran, from 2004-2020. Our analysis revealed seven main categories as challenges of eHealth policies in Iran: (1) lack of comprehensive and big picture of all eHealth components; (2) lack of long-term and strategic plans on eHealth; (3) poor consistency among national policy documents; (4) unrealistic and non-operational timing of policy documents; (5) inappropriate identification and lack of involvement of key actors in development and implementation of eHealth policies; (6) low priority of eHealth in the national health system, and (7) unconventional focus and attention to Electronic Health Record (EHR). CONCLUSION The findings reveal almost two decades history of eHealth initiatives at the national and upstream policy level in Iran, with noticeable gaps between desired policies and achieved expectations. The inclusion of eHealth solutions in the policy documents has been controversial and challenging. eHealth seems to have not been meaningfully established in the minds and views of policy makers and senior manager, which might have led to the development of incomplete and contradictory policies. The health system in Iran needs, we advocate, the design of an evidence-informed eHealth roadmap, as well as continuous, systematic, and reasonably time-bounded strategic plans to establish eHealth as the building block of health system along the pathway towards sustainable health development.
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Affiliation(s)
- Seyyed Meysam Mousavi
- Management and Leadership in Medical Education Research Center, Kerman University of Medical Sciences, Kerman, Iran
- Health Foresight and Innovation Research Center, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Bisrat A, Minda D, Assamnew B, Abebe B, Abegaz T. Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul's and Ayder Hospitals, Ethiopia. BMC Med Inform Decis Mak 2021; 21:306. [PMID: 34727948 PMCID: PMC8561912 DOI: 10.1186/s12911-021-01670-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/26/2021] [Indexed: 12/05/2022] Open
Abstract
Background In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans. Methods A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented. Results St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system. Conclusion Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01670-z.
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Affiliation(s)
- Alemayehu Bisrat
- Library and Info Service Directorate, St. Paul's Hospital Millennium Medical College, PO Box 1271, Addis Ababa, Ethiopia.
| | - Dagne Minda
- ICT Directorate, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bekalu Assamnew
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruk Abebe
- Medical Education Unit, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teshome Abegaz
- Health Informatics and Healthcare Innovation Department, School of Public Health, College of Health Sciences, Mekele University, Mekele, Ethiopia
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Olajubu EA, Aliyu E, Aderounmu AG, Hamidja KB. Managing E-Patient Case Notes in Tertiary Hospitals. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2021. [DOI: 10.4018/ijhisi.295823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Telemedicine is the use of information and communication technologies to extend healthcare work to the vulnerable in the rural areas. It is unfortunate that telemedicine is yet to be deployed in sub Sahara Africa where there is acute shortage of medical professionals with many rural dwellers without medical facilities. This paper proposes an electronic Patient’s Case-Note to replace existing manual method so as to mitigate the challenges associated with manual record keeping. The tree theory was used to motivate the information follows which the basis for the theoretical framework for the study also presented is the Cyclic structure that depicts information flow in the system. The conceptual model and the algorithms to implement the model are presented. The Model was implemented and few screenshot presented.
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Hosseini N, Mostafavi SM, Zendehdel K, Eslami S. Factors affecting clinicians' adherence to principles of diagnosis documentation: A concept mapping approach for improved decision-making. Health Inf Manag 2021; 51:149-158. [PMID: 33845621 DOI: 10.1177/1833358321991362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The quality of data in electronic health records (EHRs) depends on adherence of clinicians to principles of diagnosis documentation. OBJECTIVE A concept mapping (CM) approach was used to extract factors related to quality of clinicians' documentation that govern EHR data quality. METHOD Influential factors extracted from brainstorming sessions were sorted by individual participants, followed by a quantitative analysis using multidimensional scaling and cluster analysis to categorise sorted factors. Finally, a questionnaire was used to elicit the importance-feasibility of the extracted factors. Results were visualised by cluster maps and Go-Zone plots. RESULT Factors were classified into seven clusters: "knowledge about International Classification of Diseases and clinical coding," "need for facilitators and guidelines," "explaining the importance of the issue and defining responsibilities," "cooperation of other personnel," "codify legal requirements," "workload" and "clinical obstacles," as ranked by importance. CONCLUSION To enhance the quality of EHR data, a collaboration between physicians, nurses, managers and EHR developers is required. CM is an acceptable approach to meet this objective. Our findings highlight the significance of clinical coding knowledge, awareness about its importance and applicability and use of well-structured information systems. In combination, these three factors can have a strong positive impact on the quality of EHR data. IMPLICATIONS A list of solutions is provided for policymakers, and two interventions suggested, based on the findings of this study, including the adoption of EHRs that incorporate documentation guidelines. We further propose updated clinical training programs and a monitoring and feedback mechanism to facilitate the EHR documentation process.
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Affiliation(s)
| | - Sayyed Mostafa Mostafavi
- 37552Mashhad University of Medical Sciences, Iran.,48439Tehran University of Medical Sciences, Iran
| | | | - Saeid Eslami
- 37552Mashhad University of Medical Sciences, Iran.,University of Amsterdam, The Netherlands
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Woody Ii EW. MHS Genesis Implementation: Strategies in Support of Successful EHR Conversion. Mil Med 2021; 185:e1520-e1527. [PMID: 32699887 DOI: 10.1093/milmed/usaa184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The Military Health System (MHS) is implementing a new electronic health record (EHR) which will impact 9.5 million Department of Defense (DoD) beneficiaries and over 205,000 MHS employees globally. The scale and scope of this EHR rollout is unprecedented; however, lessons learned from previous rollouts across smaller contexts in tandem with Kurt Lewin's Change Theory provide insights into critical success factors (CSFs) and critical barriers to implementation (CBIs) in which leadership may leverage to streamline future go-live efforts. MATERIALS AND METHODS The researcher conducted a narrative literature review to identify breadth of knowledge currently available surrounding EHR implementation and change management. A Boolean search of UMGC OneSearch was conducted utilizing the search string "electronic health record* OR EHR* AND change* AND implement*" which resulted in 7,084 results. Additional inclusion criteria and limiters were then applied to these results which included full-text, scholarly, and published journal articles, written in English from January 2009 to November 2019, from Europe, the United States, and Canada, in health and medicine, military history and science, and social science and humanities disciplines. 758 articles were identified through database searching. A cursory review of titles and abstracts for goodness of fit eliminated an additional 696 articles leaving 62 for full review. 18 of these articles were used for the final literature review. Through snowballing as well as Google Scholar, eight additional articles were identified and included. Finally, as a result of MHS Genesis being a new, government-backed EHR, the researcher also utilized three pieces of gray literature and non-peer-reviewed articles from professional websites, and three articles for background regarding Lewin's Theory of Change bringing the total references to 32. RESULTS The manuscript uncovered two main themes regarding organizational change and EHR implementation. The first theme, coined CSF, includes factors associated with positive outcomes in implementing EHRs. The three CSFs are Process Change Champions, Training, and Feedback, and definitions can be found in Table I. The second theme identified, coined CBI, includes factors associated with hindering EHR implementation. The three CBIs are Technophobia, Resistance from Leaders/Providers, and Insufficient Communication, and definitions can be found in Table II. CONCLUSIONS By operationalizing pre-identified CSFs and CBIs, leaders of the MHS are able to streamline future waves of MHS Genesis rollouts utilizing Kurt Lewin's Change Theory and the newly crafted Conceptual Framework of MHS Genesis Implementation presented in Figure 1. Through full acceptance and use of CSFs, adapting to feedback and barriers, and dynamically adjusting strategies, the challenges associated with a large-scale phased EHR implementation can be minimized. The results and implications of this literature review are significant as the MHS Genesis rollout is still in its infancy and evidence-based best practices can still be executed. MHS Genesis continues to be phase implemented and currently only the Pacific Northwest and parts of California have gone operational. Increasing efficiency in this process provides a benefit to stakeholders at all levels: health care providers, patients, leadership, and taxpayers.
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Affiliation(s)
- Edward W Woody Ii
- 445th Aeromedical Staging Squadron, 445th Airlift Wing, Department of the Air Force, 4035 Vandenburg Road, Wright Patterson Air Force Base, OH 45433
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Alanazi B, Butler-Henderson K, Alanazi M. Perceptions of healthcare professionals about the adoption and use of EHR in Gulf Cooperation Council countries: a systematic review. BMJ Health Care Inform 2020; 27:bmjhci-2019-100099. [PMID: 31924667 PMCID: PMC7062356 DOI: 10.1136/bmjhci-2019-100099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/14/2019] [Accepted: 12/13/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction Electronic health records (EHRs) can improve the quality and safety of care. However, the adoption and use of the EHR is influenced by several factors, including users’ perception. Objectives To undertake a systematic review of the literature to understand healthcare professionals’ perceptions about the adoption and use of EHRs in Gulf Cooperation Council (GCC) countries in order to influence the implementation strategies, training programme and policy development in the GCC region. Method A systematic literature search was undertaken on seven online databases to identify articles published between January 2006 and December 2017 examining healthcare professionals’ perception towards the adoption and use of EHR in the Gulf context. Results The fourteen articles included in this review identified both positive and negative perceptions of the role of EHR in healthcare. The positive perceptions included EHR benefits, such as improvements to work efficiency, quality of care, communication and access to patient data. Conversely, the negative perceptions were associated with challenges or risks of adopting an EHR, such as disruption of provider–patient communication, privacy and security concerns and high initial costs. The perceptions were influenced by personal factors (eg, age, occupation and computer literacy) and system factors (perceived usefulness and perceived ease of use). Conclusion Positive perceptions of EHRs by the healthcare professionals could facilitate the adoption of this technology in the Gulf region, particularly when barriers are addressed early. Negative perceptions may inform change management strategies during adoption and implementation. The perceptions should be further evaluated from a technology acceptance perspective.
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Affiliation(s)
- Bander Alanazi
- College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | | | - Mohammed Alanazi
- College of Public Health & Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Essuman LR, Apaak D, Ansah EW, Sambah F, Ansah JE, Opare M, Ahinkorah BO. Factors associated with the utilization of electronic medical records in the Eastern Region of Ghana. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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McCrorie C, Benn J, Johnson OA, Scantlebury A. Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory. BMC Med Inform Decis Mak 2019; 19:222. [PMID: 31727063 PMCID: PMC6854727 DOI: 10.1186/s12911-019-0952-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and, in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. METHODS Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. RESULTS Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. CONCLUSIONS Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.
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Affiliation(s)
- Carolyn McCrorie
- Patient Safety Translational Research Centre, Bradford Institute of Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Jonathan Benn
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York, YO10 5DD, UK
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Gong Z, Han Z, Li X, Yu C, Reinhardt JD. Factors Influencing the Adoption of Online Health Consultation Services: The Role of Subjective Norm, Trust, Perceived Benefit, and Offline Habit. Front Public Health 2019; 7:286. [PMID: 31637229 PMCID: PMC6787145 DOI: 10.3389/fpubh.2019.00286] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
The cyberspace plays an important role in improving the quality, equity, and efficiency of health services. Studying people's adoption of online health services, such as online health consultation services (OHCS) can benefit both industry and policy in the health service sector. This paper investigates influencing factors and paths of people's intention of adopting OHCS by employing the extended valence framework, with our new contribution of integrating subjective norm and offline habit into the model. Five hundred forty-three university students participated in the survey. Structural equation models and Sobel-Goodman tests were applied to test the models. The results show that subjective norm (β = 0.077, p = 0.041), trust in providers (β = 0.194, p = 0.002) and perceived benefit (β = 0.463, p < 0.001) positively affect the intention to adopt OHCS, while offline habit (β = -0.111, p = 0.026) has a negative effect. However, the association of perceived risk (β = -0.062, p = 0.315) and adoption is not supported. Moreover, trust in providers plays a mediating role between subjective norm and the intention of adopting, while perceived benefit mediates the relationship between trust in providers and the intention of adopting. This study highlights the importance of trust, subjective norm, perceived benefit, and persisting habits in promoting the adoption of OHCS.
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Affiliation(s)
- Zepeng Gong
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ziqiang Han
- School of Political Science and Public Administration, Shandong University, Qingdao, China
| | - Xudan Li
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China.,West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chao Yu
- School of Public Administration, Sichuan University, Chengdu, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China.,Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Swanik S. Implementation of an EMR System for a Comprehensive Dental Service within a Large Regional Hospital Network: Challenges and Opportunities Presented by the Introduction of new Technology. Online J Public Health Inform 2019; 11:e19. [PMID: 31632613 PMCID: PMC6788901 DOI: 10.5210/ojphi.v11i2.10131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The development of new information technology has significant effects on the health care system, and its implementation and the associated change management process can bring some positive changes and gains in understanding, but there are challenges with making the transition. These benefits and challenges are explored in the context of a hospital based dental department. Additionally, the concept of the integration of oral health to overall systemic health is explored in context with an Electronic Medical Records system implementation, and the American Dental Association's recent recognition of dental anesthesiology as a clinical subspecialty. METHOD Qualitative survey of attending dental faculty members of the department, who represent a broad range of dental specialties and experience in private practice, hospital based practice, teaching, and public health practice. RESULTS The faculty survey yielded some consistent themes, ranging from enhanced information to make better diagnoses, to challenges in transitioning to EMR, as well as concerns about data security and too much time and effort in front of a computer screen. DISCUSSION A brief summary of the history of the stand-alone development of dentistry is given, which contributed to the separate development of dental EMRs from hospital EMRs. The various modalities of clinical care provided by the Department of Dentistry at Advocate Illinois Masonic Medical Center, Chicago, IL are presented to give a scope of the areas of need a successful EMR solution must meet in a hospital based dental setting. Public health aspects are included in the discussion. CONCLUSION Macro level health data sets (ie NHANES, state level datasets) have the potential to be expanded to include more thorough data, combining medical health data and oral health data in the same datasets.
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Affiliation(s)
- Stephen Swanik
- Division of Health Policy and Administration, Public Health
Informatics Program, School of Public Health, University of
Illinois at Chicago and Departments of Medical Education and Dentistry at
Advocate Illinois Masonic Medical Center, Chicago,
IL
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15
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Zahiri Esfahani M, Farokhzadian J, Bahaadinbeigy K, Khajouei R. Factors influencing the selection of a picture archiving and communication system: A qualitative study. Int J Health Plann Manage 2019; 34:780-793. [PMID: 30680799 DOI: 10.1002/hpm.2736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection. METHODS This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim. RESULTS Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories. CONCLUSION The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.
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Affiliation(s)
- Misagh Zahiri Esfahani
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran.,Student Research Committee, Department of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | | | - Kambiz Bahaadinbeigy
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Shelley DR, Kyriakos C, Campo A, Li Y, Khalife D, Ostroff J. An analysis of adaptations to multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings. Contemp Clin Trials Commun 2018; 11:142-148. [PMID: 30094390 PMCID: PMC6072909 DOI: 10.1016/j.conctc.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction Our team conducted a cluster randomized controlled trial (DUET) that compared the effectiveness of three theory-driven, implementation strategies on dental provider adherence to tobacco dependence treatment guidelines (TDT). In this paper we describe the process of adapting the implementation strategies to the local context of participating dental public health clinics in New York City. Methods Eighteen dental clinics were randomized to one of three study arms testing several implementation strategies: Current Best Practices (CBP) (i.e. staff training, clinical reminder system and Quitline referral system); CBP + Performance Feedback (PF) (i.e. feedback reports on provider delivery of TDT); and CBP + PF + Pay-for-Performance (i.e. financial incentives for provision of TDT). Through an iterative process, we used Stirman's modification framework to classify, code and analyze modifications made to the implementation strategies. Results We identified examples of six of Stirman's twelve content modification categories and two of the four context modification categories. Content modifications were classified as: tailoring, tweaking or refining (49.8%), adding elements (14.1%), departing from the intervention (9.3%), loosening structure (4.4%), lengthening and extending (4.4%) and substituting elements (4.4%). Context modifications were classified as those related to personnel (7.9%) and to the format/channel (8.8%) of the intervention delivery. Common factors associated with adaptations that arose during the intervention included staff changes, time constraints, changes in leadership preferences and functional limitations of to the Electronic Dental Record. Conclusions This study offers guidance on how to capture intervention adaptation in the context of a multi-level intervention aimed at implementing sustainable changes to optimize TDT in varying public health dental settings.
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Affiliation(s)
- D R Shelley
- Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - C Kyriakos
- European Network for Smoking and Tobacco Prevention, Belgium
| | - A Campo
- New York University Rory Meyers College of Nursing, 433 1st Ave, 4th Fl, New York, NY, 10003, USA
| | - Y Li
- Department of Psychiatry & Behavioral Sciences and the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - D Khalife
- Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - J Ostroff
- Tobacco Treatment Program, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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