Satisfaction of health-care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates

The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis

BACKGROUND

The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience.

OBJECTIVE

This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals.

METHODS

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes.

RESULTS

A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores.

CONCLUSIONS

Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.

Effect of electronic health records on doctor-patient relationship in Arabian gulf countries: a systematic review

Background

The electronic health record (EHR) has been widely implemented internationally as a tool to improve health and healthcare delivery. However, EHR implementation has been comparatively slow amongst hospitals in the Arabian Gulf countries. This gradual uptake may be linked to prevailing opinions amongst medical practitioners. Until now, no systematic review has been conducted to identify the impact of EHRs on doctor-patient relationships and attitudes in the Arabian Gulf countries.

Objective

To understand the impact of EHR use on patient-doctor relationships and communication in the Arabian Gulf countries.

Design

A systematic review of English language publications was performed using PRISMA chart guidelines between 1990 and 2023.

Methods

Electronic database search (Ovid MEDLINE, Global Health, HMIC, EMRIM, and PsycINFO) and reference searching restricted to the six Arabian Gulf countries only. MeSH terms and keywords related to electronic health records, doctor-patient communication, and relationship were used. Newcastle-Ottawa Scale (NOS) quality assessment was performed.

Results

18 studies fulfilled the criteria to be included in the systematic review. They were published between 1992 and 2023. Overall, a positive impact of EHR uptake was reported within the Gulf countries studied. This included improvement in the quality and performance of physicians, as well as improved accuracy in monitoring patient health. On the other hand, a notable negative impact was a general perception of physician attention shifted away from the patients themselves and towards data entry tasks (e.g., details of the patients and their education at the time of the consultation).

Conclusion

The implementation of EHR systems is beneficial for effective care delivery by doctors in Gulf countries despite some patients' perception of decreased attention. The use of EHR assists doctors with recording patient details, including medication and treatment procedures, as well as their outcomes. Based on this study, the authors conclude that widespread EHR implementation is highly recommended, yet specific training should be provided, and the subsequent effect on adoption rates by all users must be evaluated (particularly physicians). The COVID-19 Pandemic showed the great value of EHR in accessing information and consulting patients remotely.

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review

AIM

To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being.

BACKGROUND

Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety.

DESIGN

Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources.

DATA SOURCES

Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021.

RESULTS

In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory).

CONCLUSION

Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being.

IMPLICATIONS FOR THE PROFESSION

Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings.

RELEVANCE TO CLINICAL PRACTICE

Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

PROSPERO REGISTRATION NUMBER

CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).

An examination of large-scale electronic health records implementation in Primary Healthcare Centers in Saudi Arabia: a qualitative study

Introduction

Digital transformation has become a buzzword in almost every industry in the twenti first century. Healthcare is not an exception. In the healthcare industry, digital transformation includes the utilization of electronic health records (EHRs), telemedicine, health information exchange, mobile health, and other interactive platforms. The importance of digital transformation in healthcare cannot be overemphasized as it has proven to be critical in improving patient outcomes, making healthcare delivery more efficient, and reducing costs. The positive impact of electronic health records was noticed almost immediately in the field of primary healthcare. It has been suggested that implementing electronic health records will enhance the accessibility and the process of distribution of health records between authorized users. As part of Saudi vision 2030, all healthcare organizations in Saudi Arabia are going to shift to digital transformation.

Methods

This study follows a qualitative, semi-structure, face-to-face interview approach. The collected data were analyzed using NVivo V10 software. Inductive thematic analysis approach was used to analyse the collected data from the interviews.

Result

Seventeen project team members, from different positions and backgrounds were purposively chosen to be interviewed. Three main themes and 38 codes were generated from the analysis of transcripts. The informants describe the implementation of electronic health records in the PHCs based on two different experiences. The participants reported that a previous attempt failed due to inappropriate infrastructure, lack of technical support, and low level of user acceptance. Therefore, the policymakers adopted several steps to increase the level of success and avoid failure causes. They initially established well-defined requests for proposals followed by continuous commendation among the project team and conducted a consultation on multiple levels (country level; organizational level and individual level).

Conclusion

This study concluded that the main causes that lead to the failure of the large-scale project were lack of connectivity, lack of technical support, and staff changes, particularly those who occupied high-level positions in the Saudi ministry of Health. The success rate of EHRs implementation can be directly impacted by the size of the project. Large-scale projects are complicated and may be subject to numerous challenges compared with small projects. Significant factors such as training, support, legal issues, and organizational workflow and redesign were a concern of the project team during the pre-implementation phase. In addition, other factors related to technology and end-users were included in the EHRs implementation plan.

User Satisfaction of Using Electronic Medical Record System and Its Associated Factors among Healthcare Professionals in Ethiopia: A Cross-Sectional Study

Background

Electronic medical record (EMR) systems have become essential for the proper management of patients' information. Electronic medical record systems are on the rise in developing countries due to the need to ensure improved quality of healthcare. However, EMR systems can be ignored, if users are not satisfied with the implemented system. User dissatisfaction has been associated with the failure of EMR systems as a primary factor. There is also limited research done in the Ethiopian context on EMR user satisfaction at private hospitals. This study is aimed at assessing user satisfaction with electronic medical records and associated factors among health professionals working at private hospitals in Addis Ababa.

Methods

Institution-based cross-sectional quantitative study was conducted among health professionals working at private hospitals in Addis Ababa, from March to April 2021. A self-administered questionnaire was used to collect the data. EpiData version 4.6 and Stata version 25 were used for data entry and analysis, respectively. Descriptive analyses were computed for the study variables. Bivariable and multivariable logistic regression analyses were carried out to assess the significance of independent variables on dependent variables.

Results

A total of 403 (95.33% response rate) participants completed all the questionnaires. More than half of 214 (53.10%) of the participants were satisfied with the EMR system. Factors associated with user satisfaction with electronic medical records were good computer literacy (AOR = 2.92, 95% CI: [1.16-7.37]), perceived information quality (AOR = 3.54, 95% CI: [1.55-8.11]), perceived service quality (AOR = 3.15, 95% CI: [1.58-6.28]), perceived system quality (AOR = 3.05, 95% CI: [1.32-7.05]), EMR training (AOR = 4.00, 95% CI: [1.76-9.03]), computer access (AOR = 3.17, 95% CI: [1.19-8.46]), and HMIS training (AOR = 2.05, 95% CI: [1.22-6.71]).

Conclusions

In this study, health professionals' EMR satisfaction was moderate. The result showed that EMR training, computer literacy, computer access, perceived system quality, information quality, service quality, and HMIS training were associated with user satisfaction. Improving computer-related training, system quality, information quality, and service quality is an important intervention to improve the healthcare professional's satisfaction towards using electronic health record systems in Ethiopia.

Jordanian nurses' attitudes toward using electronic health records during COVID-19 pandemic

Electronic health records (EHRs) have proven their effectiveness during the coronavirus disease (COVID-19) pandemic. However, successful implementation of EHRs requires assessing nurses' attitudes as they are considered the first line in providing direct care for patients. This study assessed Jordanian nurses' attitudes and examined factors that affect nurses' attitudes toward using EHRs. A cross-sectional, correlational design was used. A convenient sample of 130 nurses was recruited from three major public hospitals in Jordan. All Participants completed the Nurses' attitudes Towards Computerization (NATC) Questionnaire. The overall nurses' attitude was positive; the mean was 61.85 (SD = 10.97). Findings revealed no significant relationship between nurses' attitudes toward using EHRs and nurses’ age, gender, education level, previous computer skills experience, years of work experience, and years of dealing with EHRs. However, the work unit was found to have a significant correlation with nurses' attitudes toward using EHRs. Therefore, nurse administrators should arrange for the conduct of educational workshops and continuous training programs considering the needs of the nurses.

Nurse Motivation, Engagement and Well-Being before an Electronic Medical Record System Implementation: A Mixed Methods Study

Implementation of an electronic medical record (EMR) is a significant workplace event for nurses in hospitals. Understanding nurses' key concerns can inform EMR implementation and ongoing optimisation strategies to increase the likelihood of nurses remaining in the nursing workforce. This concurrent mixed-methods study included surveys from 540 nurses (response rate 15.5%), and interviews with 63 nurses to examine their perceptions of using a new EMR prior to implementation at a single healthcare organisation. Survey findings revealed 32.2% (n = 174) of nurses reported low well-being scores and 28.7% (n = 155) were experiencing burnout symptoms. In contrast, 40.3% (n = 216) of nurses reported high work satisfaction, 62.3% (n = 334) had high intentions of staying in their role, and 34.3% (n = 185) were engaged in their work. Nearly half (n = 250, 46.3%) reported intrinsic motivation towards EMR use. Thematic analysis of focus group interviews revealed two themes, each with three subthemes: (1) Us and Them, detailed the juxtaposition between nurses' professional role and anticipated changes imposed on them and their work with the EMR implementation; and (2) Stuck in the middle, revealed nurses' expectations and anticipations about how the EMR may affect the quality of nurse-patient relationships. In conclusion, anticipation of the EMR implementation emerged as a stressor for nursing staff, with some groups of nurses particularly vulnerable to negative consequences to their well-being.

The Contributing Factors to Nurses' Behavioral Intention to Use Hospital Information Technologies in Ghana

Background

Medical care facilities in both developed and developing countries around the world continue to invest in hospital information technologies (HITs). Nevertheless, it has been discovered that user acceptance of these technologies is one of the imperative issues during their implementation and management in developing countries such as Ghana.

Purpose

Notably, the technology acceptance assessment of nurses is a timely one since they play a very important role in the medical sector. Based on the model of “Unified Theory of Acceptance and Use of Technology,” this study explored the factors that affect Ghanaian nurses’ acceptance of HIT.

Design/Method/Approach: A descriptive nonexperimental research design was employed in this study to recruit 660 nurses (404 females and 256 males) from 3 teaching and 2 regional hospitals in Ghana. A standardized electronic platform questionnaire (based on the Unified Theory of Acceptance and Use of Technology model) was designed on smartphones and was self-administered, while the data collected were analyzed via the SmartPLS Structural Equation Modeling path analysis. The “Social Influence” (t  = 3.656, p < .001), “Attitude towards the Use of Technology” (t = 5.861, p < .001), and “Facilitating Conditions” (t = 2.616, p < .001) were the main predictors of the nurses’ behavioral intention to use HIT. The effects of the aforementioned constructs explained 60.7% (R²= 0.607) of the variance in the nurses’ intentions to use the HIT systems.

Conclusions

Precisely, HIT systems are essential in the quality and the enhancement of nursing services provision and in the effectiveness of the performance of nursing staff. This study, therefore, offers a piece of empirical evidence for hospital administrators in developing countries especially Ghana, to assess the success probability of new HITs before and after their implementation.

Challenges for developing health-care knowledge in the digital age

Purpose

Health-care knowledge is dispersed among different departments in a health care organization, which makes it difficult at times to provide quality care services to patients. Therefore, this study aims to identify the main challenges in adopting health information technology (HIT).

Design/methodology/approach

This study surveyed 148 stakeholders in 4 key categories [patients, health-care providers, United Arab Emirates (UAE) citizens and foresight experts] to identify the challenges they face in adopting health care technologies. Responses were analyzed using exploratory (EFA) and confirmatory factor analysis (CFA).

Findings

EFA revealed four key latent factors predicting resistance to HIT adoption, namely, organizational strategy (ORGS); technical barriers; readiness for big data and the internet of things (IoT); and orientation (ORI). ORGS accounted for the greatest amount of variance. CFA indicated that readiness for big data and the IoT was only moderately correlated with HIT adoption, but the other three factors were strongly correlated. Specific items relating to cost, the effectiveness and usability of the technology and the organization were strongly correlated with HIT adoption. These results indicate that, in addition to financial considerations, effective HIT adoption requires ensuring that technologies will be easy to implement to ensure their long-term use.

Research limitations/implications

The results indicate that readiness for big data and the IoT-related infrastructure poses a challenge to HIT adoption in the UAE context. Respondents believed that the infrastructure of big data can be helpful in more efficiently storing and sharing health-care information. On the technological side, respondents felt that they may experience a steep learning curve. Regarding ORI, stakeholders expected many more such initiatives from health-care providers to make it more knowledge-specific and proactive.

Practical implications

This study has implications for knowledge management in the health -care sector for information technologies. The HIT can help firms in creating a knowledge eco-system, which is not possible in a dispersed knowledge environment. The utilization of the knowledge base that emerged from the practices and data can help the health care sector to set new standards of information flow and other clinical services such as monitoring the self-health condition. The HIT can further influence the actions of the pharmaceutical and medical device industry.

Originality/value

This paper highlights the challenges in HIT adoption and the most prominent factors. The conceptual model was empirically tested after the collection of primary data from the UAE using stakeholder theory.

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

Privacy, confidentiality, security and patient safety concerns about electronic health records

AIMS

This study explored concerns among nurses working in the United Arab Emirates associated with the use of electronic health records, including privacy, confidentiality, security and patient safety.

BACKGROUND

Given the widespread implementation of electronic health records, there are concerns about data integrity that could jeopardize healthcare quality. Addressing nurses' concerns about data integrity and safety is critical to inform health policies and promote public trust.

METHODS

Nurses working in healthcare settings in the United Arab Emirates (N = 562) were invited to share their concerns about data integrity and patient safety using a mixed-method approach. Data were collected between January and June 2018 via questionnaires and focus group interviews. Following a survey of nurses' concerns about privacy, confidentiality, security and patient safety in electronic health records, six focus groups were held to gain deeper insights about their concerns. Major themes that emerged from the focus groups were extracted to align with the main sections of the questionnaire.

RESULTS

Nurses expressed concern over the security of electronic health records (n = 270, 48%). Administrative-related security, inadequate training and access by unauthorized users were the most frequently reported concerns. The main patient safety concerns were associated with non-technological factors, including lack of audit by staff, poor communication with technology vendors and length of time required for documentation. The focus group results reflected similar issues, with an additional theme being inconsistency in data integrity policies.

CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY

Frontline nurse managers need to integrate pragmatic policies to support staff compliance with the code of ethics when using online data. Nurses must follow workplace policies that foster reporting of risks to online incident systems to ensure data integrity. A unified health policy based on multidisciplinary partnership is critical to safeguard online data and promote public trust.

An evaluation of the user-friendliness of Bayesian forecasting programs in a clinical setting

AIMS

To evaluate 3 Bayesian forecasting (BF) programs-TDMx, InsightRx and DoseMe-on their user-friendliness and common liked and disliked features through a survey of hospital pharmacists.

METHODS

Clinical pharmacists across 3 Australian hospitals that did not use a BF program were invited to a BF workshop and complete a survey on programs they trialled. Participants were given 4 case scenarios to work through and asked to complete a 5-point Likert scale survey evaluating the program's user-friendliness. Liked and disliked features of each program were ascertained through written responses to open-ended questions. Survey results were compared using a χ² test of equal or given proportions to identify significant differences in response.

RESULTS

Twenty-seven pharmacists, from hospitals, participated. BF programs were rated overall as user-friendly with 70%, 41% and 37% (P = .02) of participants recording a Likert score of 4 or 5 for DoseMe, TDMx and InsightRx, respectively. Participants found it easy to access all required information to use the programs, understood dosing recommendations and visualisations given by each program, and thought programs supported decision-making with >50% of participants scoring a 4 or 5 across the programs in these categories. Common liked features across all programs were the graphical displays and ease of data entry, while common disliked features were related to the units, layout and information display.

CONCLUSION

Although differences exist between programs, all 3 programs were most commonly rated as user-friendly across all themes evaluated, which provides useful information for healthcare facilities wanting to implement a BF program.