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Lopes J, Faria M, Santos MF. Exploring trends and autonomy levels of adaptive business intelligence in healthcare: A systematic review. PLoS One 2024; 19:e0302697. [PMID: 38728308 PMCID: PMC11086907 DOI: 10.1371/journal.pone.0302697] [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: 11/24/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE In order to comprehensively understand the characteristics of Adaptive Business Intelligence (ABI) in Healthcare, this study is structured to provide insights into the common features and evolving patterns within this domain. Applying the Sheridan's Classification as a framework, we aim to assess the degree of autonomy exhibited by various ABI components. Together, these objectives will contribute to a deeper understanding of ABI implementation and its implications within the Healthcare context. METHODS A comprehensive search of academic databases was conducted to identify relevant studies, selecting AIS e-library (AISel), Decision Support Systems Journal (DSSJ), Nature, The Lancet Digital Health (TLDH), PubMed, Expert Systems with Application (ESWA) and npj Digital Medicine as information sources. Studies from 2006 to 2022 were included based on predefined eligibility criteria. PRISMA statements were used to report this study. RESULTS The outcomes showed that ABI systems present distinct levels of development, autonomy and practical deployment. The high levels of autonomy were essentially associated with predictive components. However, the possibility of completely autonomous decisions by these systems is totally excluded. Lower levels of autonomy are also observed, particularly in connection with prescriptive components, granting users responsibility in the generation of decisions. CONCLUSION The study presented emphasizes the vital connection between desired outcomes and the inherent autonomy of these solutions, highlighting the critical need for additional research on the consequences of ABI systems and their constituent elements. Organizations should deploy these systems in a way consistent with their objectives and values, while also being mindful of potential adverse effects. Providing valuable insights for researchers, practitioners, and policymakers aiming to comprehend the diverse levels of ABI systems implementation, it contributes to well-informed decision-making in this dynamic field.
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Affiliation(s)
- João Lopes
- ALGORITMI Research Center, University of Minho, Braga, Portugal
| | - Mariana Faria
- ALGORITMI Research Center, University of Minho, Braga, Portugal
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Malhan AS, Sadeghi-R K, Pavur R, Pelton L. Healthcare information management and operational cost performance: empirical evidence. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01641-3. [PMID: 37950806 DOI: 10.1007/s10198-023-01641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/12/2023] [Indexed: 11/13/2023]
Abstract
Healthcare knowledge management systems can mitigate hospitals' operational inefficiency. As a healthcare information technology, the electronic health record (EHR) receives much attention from medical institutions due to its considerable impact on operational cost performance. This paper focuses on EHR systems to address operational inefficiency by which patients pay more for health care services, and many U.S. hospitals are filing for bankruptcy. From the theoretical perspective of the practice-based view, this paper introduces a path to implement EHR systems for improving cost performance. The empirical investigation is archival data of 200 hospitals collected from the U.S. healthcare agencies. Findings contribute to prior work by hypothesizing moderating and mediating roles in EHR systems implementation. This paper introduces absorptive capacity and monitoring mechanisms as enablers of implementing EHR systems. The results showed that hospital monitoring strengthens the relationship between absorptive capacity and electronic health record systems implementation, which results in better operational cost performance. Theoretically, this study supports the long-term potential benefits of EHR adoption, and its findings are consistent with optimizing efficiency through data standardization and interoperability. From a practical perspective, this study supports hospitals' investments in evolving healthcare information technology systems through the development of a knowledge-based system employing EHR, particularly when hospitals are merging or need a financial strategic plan to control expenses.
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Affiliation(s)
- Amit S Malhan
- Department of Marketing and Supply Chain Management, Willie A. Deese College of Business and Economics, North Carolina Agricultural and Technical State University, Greensboro, NC, 27401, USA
| | - Kiarash Sadeghi-R
- Department of Marketing and Supply Chain Management, Willie A. Deese College of Business and Economics, North Carolina Agricultural and Technical State University, Greensboro, NC, 27401, USA.
| | - Robert Pavur
- Department of Information Technology and Decision Sciences, G. Brint Ryan College of Business, University of North Texas, Denton, TX, 76203, USA
| | - Lou Pelton
- Department of Marketing, G. Brint Ryan College of Business, University of North Texas, Denton, TX, 76203, USA
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Tun SYY, Madanian S. Clinical information system (CIS) implementation in developing countries: requirements, success factors, and recommendations. J Am Med Inform Assoc 2023; 30:761-774. [PMID: 36749093 PMCID: PMC10018272 DOI: 10.1093/jamia/ocad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Clinical Information System (CIS) usage can reduce healthcare costs over time, improve the quality of medical care and safety, and enhance clinical efficiency. However, CIS implementation in developing countries poses additional, different challenges from the developed countries. Therefore, this research aimed to systematically review the literature, gathering and integrating research findings on Success Factors (SFs) in CIS implementation for developing countries. This helps to integrate past knowledge and develop a set of recommendations, presented as a framework, for implementing CIS in developing countries. MATERIALS AND METHODS A systematic literature review was conducted, followed by qualitative data analysis on the published articles related to requirements and SF for CIS implementation. Eighty-three articles met the inclusion criteria and were included in the data analysis. Thematic analysis and cross-case analysis were applied to identify and categorize the requirements and SF for CIS implementation in developing countries. RESULTS Six major requirement categories were identified including project management, financial resources, government involvement and support, human resources, organizational, and technical requirements. Subcategories related to SF are classified under each major requirement. A set of recommendations is provided, presented in a framework, based on the project management lifecycle approach. CONCLUSION The proposed framework could support CIS implementations in developing countries while enhancing their rate of success. Future studies should focus on identifying barriers to CIS implementation in developing countries. The country-specific empirical studies should also be conducted based on this research's findings to match the local context.
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Affiliation(s)
- Soe Ye Yint Tun
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
| | - Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
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Mukherjee SK, Olivieri DJ, Madhani SI, Bonfield CM, Mbabazi E, Arman DM, Dewan MC, Ekramullah SM. EMR adoption in Dhaka, Bangladesh: a template to index pediatric central nervous system tumor care and a review of preliminary neuro-oncologic observations. Childs Nerv Syst 2022; 38:1497-1504. [PMID: 35588333 PMCID: PMC9118804 DOI: 10.1007/s00381-022-05450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the design, implementation, and adoption of a simplified electronic medical record (EMR) and its use in documenting pediatric central nervous system (CNS) tumors at a tertiary care referral hospital in South-East Asia. METHODS A novel EMR, cataloguing pediatric CNS tumors was used to collect data from August 2017 to March 2020 at National Institute of Neurosciences and Hospital (NINS&H) in Dhaka, Bangladesh. RESULTS Two hundred forty-nine pediatric patients with a CNS tumor were admitted to NINS&H. Fifty-eight percent of patients were male, and the median age was 8 years. A total of 188/249 patients (76%) underwent surgery during their index admission. Radiographic locations were known for 212/249 (85%) of cases; the most common radiographic locations were infratentorial (81/212; 38%), suprasellar (45/212; 21%), and supratentorial (29/212; 14%). A histopathological classification was reported on 156/249 (63%) of patients' cytology. The most common infratentorial pathologies were medulloblastoma (22/47; 47%) and pilocytic astrocytoma (14/47; 30%). The median time between admission and surgery was 36 days, while the median post-operation stay was 19.5 days. CONCLUSIONS The feasibility of a basic EMR platform for a busy pediatric neurosurgery department in a lower-middle income country is demonstrated, and preliminary clinical data is reviewed. A wide variety of pediatric CNS tumors were observed, spanning the spectrum of anatomic locations and histopathologic subtypes. Surgical intervention was performed for the majority of patients. Barriers to care include limited molecular diagnostics and unavailable data on adjuvant therapy. Future targets include improvement of clinical documentation in the pre-operative and post-operative period.
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Affiliation(s)
- Sudipta Kumer Mukherjee
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Daniel J. Olivieri
- grid.40263.330000 0004 1936 9094Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Sarosh Irfan Madhani
- grid.7147.50000 0001 0633 6224Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Christopher M. Bonfield
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Edith Mbabazi
- grid.461319.8CURE Children’s Hospital of Uganda, Mbale, Uganda
| | - D. M. Arman
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Michael C. Dewan
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Sheikh Muhammad Ekramullah
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
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Kisekka V, Goel S, Williams K. Disambiguating Between Privacy and Security in the Context of Health Care: New Insights on the Determinants of Health Technologies Use. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2021; 24:617-623. [PMID: 34152853 DOI: 10.1089/cyber.2020.0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Health care providers are increasingly providing technologies for patient care; however, patients are still loath to use such technologies consistently. This research examines the impediments to patients' use of e-health portals. Our analysis of 836 data records showed that while privacy and security concerns have a negative impact on attitudes toward e-health portals, increasing the awareness of privacy and security controls alleviates such concerns. Our findings also suggest that individuals worry more about who possesses the right to access their health data (i.e., who, what, when, and why) than the mechanisms used to safeguard data from unauthorized access. We found that perceived benefits and support (i.e., emotional and technical support) positively influenced the determinants of use intentions. The implications of these findings for health care providers and policy makers are discussed.
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Affiliation(s)
- Victoria Kisekka
- Information Security and Digital Forensics, School of Business, University at Albany, State University of New York, Albany, New York, USA
- Massry Center for Business (BB) 371, University at Albany, State University of New York, Albany, New York, USA
| | - Sanjay Goel
- Information Security and Digital Forensics, School of Business, University at Albany, State University of New York, Albany, New York, USA
| | - Kevin Williams
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA
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Esdar M, Hübner U, Thye J, Babitsch B, Liebe JD. The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data. JMIR Med Inform 2021; 9:e23306. [PMID: 33720029 PMCID: PMC8077601 DOI: 10.2196/23306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Johannes Thye
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Birgit Babitsch
- Institute of Health and Education, New Public Health, Osnabrück University, Osnabrueck, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany.,Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Fennelly O, Cunningham C, Grogan L, Cronin H, O'Shea C, Roche M, Lawlor F, O'Hare N. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform 2020; 144:104281. [PMID: 33017724 PMCID: PMC7510429 DOI: 10.1016/j.ijmedinf.2020.104281] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 11/03/2022]
Abstract
AIM To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts. INTRODUCTION Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders. METHODS A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel. RESULTS Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing. CONCLUSION Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | | | - Conor O'Shea
- Irish College of General Practitioners, Ireland..
| | - Miriam Roche
- Maternal and Newborn Clinical Management System National Project Team, HSE, Ireland.
| | | | - Neil O'Hare
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland; Ireland East Hospital Group, HSE, Ireland.
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Smith N, Burton-Jones A, Sullivan C. From benefits idealisation to value optimisation: application in the digital health context. AUST HEALTH REV 2020; 44:706-722. [PMID: 32981571 DOI: 10.1071/ah19255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/21/2020] [Indexed: 01/08/2023]
Abstract
Objective This study investigated evidence for the approach known as 'benefits management' (BM) used in many digital hospital initiatives. Methods A qualitative narrative overview was conducted on the BM literature and compared with a qualitative systematic overview of electronic medical record (EMR) implementation literature. Results Twenty-five articles on BM and 12 literature reviews on EMR implementation were examined. The BM approach does not have strong support in the literature and does not support all the needs of large EMR implementations. Conclusion The current BM approach provides an inadequate basis for managing and reporting on the outcomes that ensue from a digital hospital initiative. A shift is needed from benefits idealisation to value optimisation. What is known about the topic? Health services are under increasing pressure to demonstrate that the benefits anticipated from digital health investments have been realised. What does this paper add? This paper informs the practice of benefits governance in EMR implementations. The results reveal inadequacies in current BM models and practice that are currently enshrined in policy despite a lack of evidence. What are the implications for practitioners? Health service leaders must be willing to question the governance of benefits from health service transformations using more evidence-based approaches to increase the value obtained from investments in digital transformation.
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Affiliation(s)
- Natalie Smith
- UQ Business School, Blair Drive, St Lucia, Qld 4072, Australia. ; and Corresponding author.
| | | | - Clair Sullivan
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston Road, Qld 4006, Australia. ; and Present address: School of Medicine, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia
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Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. AUST HEALTH REV 2020; 43:302-313. [PMID: 29792259 DOI: 10.1071/ah17153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Clair Sullivan
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Andrew Staib
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
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Wong MC, Huang J, Chan PS, Lok V, Leung C, Wang J, Cheung CS, Wong WN, Cheung NT, Ho CP, Yeoh EK. The Perceptions of and Factors Associated With the Adoption of the Electronic Health Record Sharing System Among Patients and Physicians: Cross-Sectional Survey. JMIR Med Inform 2020; 8:e17452. [PMID: 32436855 PMCID: PMC7273237 DOI: 10.2196/17452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 02/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The electronic health record sharing system (eHRSS) was implemented as a new health care delivery platform to facilitate two-way communication between the public and private sectors in Hong Kong.
Objective
This study aimed to investigate the perceptions of and factors associated with the adoption of eHRSS among patients, the general public, and private physicians.
Methods
Telephone interviews were conducted in 2018 by using a simple random sampling strategy from a list of patients who had enrolled in the eHRSS and a territory-wide telephone directory for nonenrolled residents. We completed 2000 surveys (1000 each for enrolled and nonenrolled individuals). Private physicians completed self-administered questionnaires, including 762 valid questionnaires from 454 enrolled physicians and 308 nonenrolled physicians.
Results
Most participants (707/1000, 70.70%) were satisfied with the overall performance of the eHRSS. Regarding registration status, most nonenrolled patients (647/1000, 64.70%) reported that “no recommendation from their physicians and family members” was the major barrier, whereas more than half of the physicians (536/1000, 53.60%) expressed concerns on “additional workload due to use of eHRSS.” A multivariate regression analysis showed that patients were more likely to register when they reported “other service providers could view the medical records” (adjusted odds ratio [aOR] 6.09, 95% CI 4.87-7.63; P<.001) and “friends’ or family’s recommendation or assistance in registration” (aOR 3.51, 95% CI 2.04-6.03; P=.001). Physicians were more likely to register when they believed that the eHRSS could improve the quality of health care service (aOR 4.70, 95% CI 1.77-12.51; P=.002) and were aware that the eHRSS could reduce duplicated tests and treatments (aOR 4.16, 95% CI 1.73-9.97; P=.001).
Conclusions
Increasing the possibility of viewing patients' personal medical record, expanding the sharable data scope for patients, and highlighting the benefits of the system for physicians could be effective to enhance the adoption of the eHRSS.
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Affiliation(s)
- Martin Cs Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Paul Sf Chan
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Veeleah Lok
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Colette Leung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Jingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Clement Sk Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong
| | - Chung Ping Ho
- Information Technology Committee, Hong Kong Medical Association, Hong Kong
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Hu X, Qu H, Houser SH, Chen H, Zhou J, Yu M. Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals. Risk Manag Healthc Policy 2020; 13:295-301. [PMID: 32308512 PMCID: PMC7135123 DOI: 10.2147/rmhp.s241553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52–3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22–2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34–2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.
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Affiliation(s)
- Xuejun Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huoliang Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Jinming Zhou
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Min Yu
- Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, People's Republic of China
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12
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Lu Z, Cui T, Tong Y, Wang W. Examining the effects of social influence in pre-adoption phase and initial post-adoption phase in the healthcare context. INFORMATION & MANAGEMENT 2020. [DOI: 10.1016/j.im.2019.103195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Yong See Q. Attitudes and Perceptions of General Practitioners towards the National Electronic Health Record (NEHR) in Singapore. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/19-00184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: In Singapore, the National Electronic Health Record (NEHR) was launched in 2011. The central ethos of the initiative was that of “One Patient, One Health Record”, as NEHR allows registered doctors to review and upload patient data. However, uptake of the system has been slow in the private sector, with only 27% of doctors with private licenses, including general practitioners (GP) and specialists in the ambulatory care setting, accessing it. A questionnaire-based study was therefore conducted to find out the proportion of GP who used NEHR, and the barriers faced by those who do not.
Methods: This study involved a self-administered questionnaire, randomly sampling private GP in Singapore. The questionnaire ascertained the number of GP who used NEHR and gathered their demographic information. A 5-point Likert scale was used to measure the perceived barriers to NEHR use.
Results: Of the 315 responses, multinomial logistics regression showed that solo-practising GP who were >40 years old and who had practised for >15 years were less likely to review, or review and upload, data onto NEHR. Doctors who regarded themselves as computer users with lower levels of technical aptitude and those who perceived an inadequate level of support were less likely to use the NEHR. The majority of GP had a positive attitude towards NEHR.
Conclusions: This study highlighted key demographics and perceived barriers affecting NEHR use. By raising awareness of these issues to policy makers and working to overcome these barriers, NEHR use may be increased.
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Affiliation(s)
- Qin Yong See
- Care and Health Integration, Changi General Hospital, Simei, Singapore
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14
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Hansen S, Baroody AJ. Electronic Health Records and the Logics of Care: Complementarity and Conflict in the U.S. Healthcare System. INFORMATION SYSTEMS RESEARCH 2020. [DOI: 10.1287/isre.2019.0875] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Sean Hansen
- Saunders College of Business, Rochester Institute of Technology, Rochester, New York 14623
| | - A. James Baroody
- Saunders College of Business, Rochester Institute of Technology, Rochester, New York 14623
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15
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Abstract
BACKGROUND The electronic medical record (EMR) is considered to be a vital tool of information and communication technology (ICT) to improve the quality of medical care, but the limited adoption of EMR by physicians results in a considerable warning to its successful implementation. The purpose of the present review is to explore and identify the potential barriers perceived by physicians in the adoption of EMR. METHODS The systematic review was carried out based on literature published in 5 databases: PubMed, Web of Science, Scopus, The Cochrane Library, and ProQuest from 2014 to 2018, concerning barriers perceived by physicians to the adoption of EMR. RESULTS The present study incorporates 26 articles based on their appropriateness out of 1354 for the final analysis. Authors explore 25 barriers that appeared 112 times in the literature for the present review; the top 5 frequently mentioned barriers are privacy and security concerns, high start-up cost, workflow changes, system complexity, lack of reliability, and interoperability. CONCLUSION The systematic review explores that physicians deal with different barriers as they intend to adopt EMR. The barriers explored in the present review are the potential to play as references for the implementer of the EMR system. Thus an attentive analysis of the definitive condition is needed before relevant intervention is determined as the implementation of EMR must be considered as a behavioral change in medical practice.
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16
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Liang D, Darko AP, Zeng J. Interval-valued pythagorean fuzzy power average-based MULTIMOORA method for multi-criteria decision-making. J EXP THEOR ARTIF IN 2019. [DOI: 10.1080/0952813x.2019.1694589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Decui Liang
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China
| | - Adjei Peter Darko
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China
| | - Ju Zeng
- Department of Radiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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17
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V. V, M. S, Dutta P. Modelling the readiness factors for agility in healthcare organization: a TISM approach. BENCHMARKING-AN INTERNATIONAL JOURNAL 2019. [DOI: 10.1108/bij-06-2018-0172] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to identify and analyze the interactions among different readiness factors for implementing agility in healthcare organization. Total interpretive structural modeling (TISM) based readiness framework for agility has been developed to understand the mutual interactions among the factors and to identify the driving and dependence power of these factors.
Design/methodology/approach
The identification of factors is done by TISM approach used for analyzing the mutual interactions between factors. Cross-impact matrix multiplication applied to classification analysis is utilized to find the driving and dependent factors of agile readiness in healthcare.
Findings
This paper identifies 12 factors of readiness for change in literature review, which is followed by an expert interview to understand the interconnection of factors and to study interrelationships of factors. The study suggests that factors like environmental scanning, resource availability, innovativeness, cost effectiveness, organizational leadership, training and development are important for implementing/improving the readiness of agility in healthcare organizations.
Research limitations/implications
This research focuses mainly on readiness factors for agility in healthcare sector.
Practical implications
Top management must stress on readiness factors that have a strong driving power for efficient implementation of agility in healthcare. This study helps the managers to take quick decisions, and continuous monitoring of readiness factors would be more beneficial to improve the quality of service, which makes the organization more agile.
Originality/value
In this research, TISM-based readiness for agile framework structural model has been proposed for healthcare organizations, which is a new effort for implementation of agility in healthcare.
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18
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A Hybrid MCDM Model for Improving the Electronic Health Record to Better Serve Client Needs. SUSTAINABILITY 2017. [DOI: 10.3390/su9101819] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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19
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Structured Data Entry in the Electronic Medical Record: Perspectives of Pediatric Specialty Physicians and Surgeons. J Med Syst 2017; 41:75. [PMID: 28324321 DOI: 10.1007/s10916-017-0716-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use. Physician resistance to SDES is multifactorial. A 35-item questionnaire based on Unified Theory of Acceptance and Use of Technology, was used to measure attitudes, facilitation, and potential incentives for adopting SDES for clinical documentation among 25 pediatric specialty physicians and surgeons. Statistical analysis included chi-square for categorical data as well as independent sample t-tests and analysis of variance for continuous variables. Mean scores of the nine constructs demonstrated primarily positive physician attitudes toward SDES, while the surgeons were neutral. Those under 40 were more likely to respond that facilitating conditions for structured entry existed as compared to the two older age groups (p = .02). Pediatric surgeons were significantly less positive than specialty physicians about SDES effects on Performance (p = .01) and the effect of Social Influence (p = .02); but in more agreement that use of forms was voluntary (p = .02). Attitudinal differences likely reflect medical training, clinical practice workflows, and division specific practices. Identified resistance indicate efforts to increase SDES adoption should be discipline-targeted rather than a uniform approach.
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Barriers to Electronic Health Record Adoption: a Systematic Literature Review. J Med Syst 2016; 40:252. [PMID: 27714560 PMCID: PMC5054043 DOI: 10.1007/s10916-016-0628-9] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/16/2022]
Abstract
Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.
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Kruse CS, Kothman K, Anerobi K, Abanaka L. Adoption Factors of the Electronic Health Record: A Systematic Review. JMIR Med Inform 2016; 4:e19. [PMID: 27251559 PMCID: PMC4909978 DOI: 10.2196/medinform.5525] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/03/2016] [Accepted: 03/21/2016] [Indexed: 11/19/2022] Open
Abstract
Background The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. Objective The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. Methods Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. Results Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. Conclusions The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates.
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Affiliation(s)
- Clemens Scott Kruse
- Texas State University, School of Health Administration, San Marcos, TX, United States.
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Shareef MA, Dwivedi YK, Laumer S, Archer N. Citizens’ Adoption Behavior of Mobile Government (mGov): A Cross-Cultural Study. INFORMATION SYSTEMS MANAGEMENT 2016. [DOI: 10.1080/10580530.2016.1188573] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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