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Qvist A, Mullan L, Nguyen L, Wynter K, Rasmussen B, Goh M, Feely K. Investigating allied health professionals' attitudes, perceptions and acceptance of an electronic medical record using the Unified Theory of Acceptance and Use of Technology. AUST HEALTH REV 2024; 48:16-27. [PMID: 38281312 DOI: 10.1071/ah23092] [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: 01/30/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
Objective This study aimed to investigate allied health professionals' (AHPs') perspectives pre- and post-implementation of an electronic medical record (EMR) in a tertiary health service in Australia and examine factors influencing user acceptance. Methods Data were collected pre- and post-EMR implementation via cross-sectional online surveys based on the Unified Theory of Acceptance and Usage of Technology (UTAUT). All AHPs at a large tertiary hospital were invited to complete the surveys. Data analysis included descriptive analysis, Mann-Whitney U tests for pre-post item- and construct-level comparison and content analysis of free-text responses. The theoretical model was empirically tested using partial least squares structural equation modelling. Results AHPs had positive attitudes toward EMR use both pre- and post-implementation. Compared to pre-implementation, AHPs felt more positive post-implementation about system ease of use and demonstrated decreased anxiety and apprehension regarding EMR use. AHPs felt they had adequate resources and knowledge to use EMR and reported real-time data accessibility as a main advantage. Disadvantages of EMR included an unfriendly user interface, system outages and decreased efficiency. Conclusions As AHPs increase EMR system familiarity, their positivity towards its use increases. An understanding of what influences AHPs when implementing new compulsory technology can inform change management strategies to improve adoption.
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Affiliation(s)
- Alison Qvist
- Western Health, Digital Health, Footscray, Vic. 3011, Australia
| | - Leanne Mullan
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia; and School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia
| | - Lemai Nguyen
- Department of Information Systems and Business Analytics, Deakin Business School, Deakin University, Burwood, Vic., Australia
| | - Karen Wynter
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia; and Department of Psychiatry, Monash University, Clayton, Vic. 3168, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia; and The Centre for Quality and Patient Safety Research in the Institute of Health Transformation, Deakin University - Western Health Partnership, St Albans, Vic., Australia; and Faculty of Health Sciences, University of Southern Denmark and Steno Diabetes Center, Copenhagen, Denmark; and Faculty of Health and Medical Sciences, University of Copenhagen, Odense, Denmark
| | - Min Goh
- Western Health, Digital Health, Footscray, Vic. 3011, Australia
| | - Kath Feely
- Western Health, Digital Health, Footscray, Vic. 3011, Australia; and Royal Melbourne Hospital, EMR team, Parkville, Vic. 3052, Australia
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Derecho KC, Cafino R, Aquino-Cafino SL, Isla A, Esencia JA, Lactuan NJ, Maranda JAG, Velasco LCP. Technology adoption of electronic medical records in developing economies: A systematic review on physicians' perspective. Digit Health 2024; 10:20552076231224605. [PMID: 38222081 PMCID: PMC10787531 DOI: 10.1177/20552076231224605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024] Open
Abstract
Electronic Medical Records (EMRs) are a tool that could potentially improve the outcomes of patient care by providing physicians with access to up-to-date and accurate vital patient information. Despite this potential, EMR adoption in developing economies has been dilatory. This systematic review aims to synthesize the related literature on the adoption of EMRs in developing economies, with a focus on the perspective of physicians. With the aim to discern the key factors that impact EMR adoption as perceived by physicians and to offer guidance for future research on filling any gaps identified in the existing literature, this study utilized a systematic literature review by following the PRISMA guidelines. Out of 1160 initial articles, 21 were selected for analysis after eliminating duplicates and non-qualifying articles. Results show that common enablers of EMR adoption from physicians' perspective were identified to be computer literacy, education, voluntariness, and the system functionality including its features and user interface, implying that the provision of proper interventions focusing on the aspects of the health information system has an impact in maximizing the utilization and capabilities of EMRs among healthcare providers. The most prevalent barriers include the lack of training and IT usage experience along with resistance to changes associated with respondents' age and gender, the lack of time for learning complex EMR systems, and costs of the new technology. This indicates that a thorough planning and proper budget allocation is necessary prior to implementing and integrating EMR systems in healthcare institutions. From this synthesis of the common research conclusions, limitations, and recommendations from physicians' perspective, the result of this systematic review is expected to shed light on the optimal technology adoption of EMRs and its contribution to the health care systems of developing economies.
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Affiliation(s)
- Karyl Claire Derecho
- Mindanao State University-Iligan Institute of Technology, Iligan City, The Philippines
| | - Rentor Cafino
- Zamboanga City Medical Center, Zamboanga City, The Philippines
| | | | - Armando Isla
- Mercy Community Hospital, Iligan City, The Philippines
| | - Jay Ar Esencia
- La Paz Municipal Hospital, La Paz, Agusan del Sur, The Philippines
| | - Nove Joshua Lactuan
- Mindanao State University-Iligan Institute of Technology, Iligan City, The Philippines
- STI College Iligan, Iligan City, The Philippines
| | | | - Lemuel Clark P Velasco
- Mindanao State University-Iligan Institute of Technology, Iligan City, The Philippines
- Premiere Research Institute of Science and Mathematics – Center for Computational Analytics and Modelling, MSU-IIT, Iligan City, The Philippines
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Diel S, Doctor E, Reith R, Buck C, Eymann T. Examining supporting and constraining factors of physicians' acceptance of telemedical online consultations: a survey study. BMC Health Serv Res 2023; 23:1128. [PMID: 37858170 PMCID: PMC10588103 DOI: 10.1186/s12913-023-10032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
As healthcare demands exceed outpatient physicians' capacities, telemedicine holds far-reaching potential for both physicians and patients. It is crucial to holistically analyze physicians' acceptance of telemedical applications, such as online consultations. This study seeks to identify supporting and constraining factors that influence outpatient physicians' acceptance of telemedicine.We develop a model based on the unified theory of acceptance and use of technology (UTAUT). To empirically examine our research model, we conducted a survey among German physicians (n = 127) in 2018-2019. We used the partial least squares (PLS) modeling approach to test our model, including a mediation analysis. The results indicate that performance expectancy (β = .397, P < .001), effort expectancy (β = .134, P = .03), and social influence (β = .337, P < .001) strongly impact the intention to conduct online consultations and explain 55% of its variance. Structural conditions regarding data security comprise a key antecedent, associating with performance expectancy (β = .193, P < .001) and effort expectancy (β = .295, P < .001). Regarding potential barriers to usage intentions, we find that IT anxiety predicts performance (β = -.342, P < .001) and effort expectancy (β = -.364, P < .001), while performance expectancy fully mediates (βdirect = .022, P = .71; βindirect = -.138, P < .001) the direct relationship between IT anxiety and the intention to use telemedical applications.This research provides explanations for physicians' behavioral intention to use online consultations, underlining UTAUT's applicability in healthcare contexts. To boost acceptance, social influences, such as personal connections and networking are vital, as colleagues can serve as multipliers to reach convergence on online consultations among peers. To overcome physicians' IT anxiety, training, demonstrations, knowledge sharing, and management incentives are recommended. Furthermore, regulations and standards to build trust in the compliance of online consultations with data protection guidelines need reinforcement from policymakers and hospital management alike.
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Affiliation(s)
- Sören Diel
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
| | - Eileen Doctor
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany.
| | - Riccardo Reith
- Chair of General Business Management, University of Bayreuth, Universitätsstraße 30, 95447, Bayreuth, Germany
| | - Christoph Buck
- Faculty of Informatics, Augsburg University of Applied Sciences and Branch Business & Information Systems Engineering of the Fraunhofer FIT, Alter Postweg 101, 86159, Augsburg, Germany
- QUT Business School, Centre for Future Enterprise, Queensland University of Technology, 2 George St, Brisbane, QLD-4000, Australia
| | - Torsten Eymann
- Branch Business & Information Systems Engineering of the Fraunhofer FIT and FIM Research Center for Information Management, University of Bayreuth, Wittelsbacherring 10, 95444, Bayreuth, Germany
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Abbasi H, Rahimi B, Jebraeily M, Nourani A. End-users' perspectives on factors affecting implementation and utilization of the Iranian electronic health record system: a qualitative study in a developing country. BMC Health Serv Res 2023; 23:1064. [PMID: 37798629 PMCID: PMC10557278 DOI: 10.1186/s12913-023-10033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND As one of the most important information technologies for storing, managing, and exchanging health information, the electronic health record (EHR) plays a major role in the health system. However, these systems in developing countries have been associated with multidimensional issues. The purpose of the present study was the assessment of nonclinical end-users' points of view on the implementation and utilization of the Iranian electronic health record system. METHODS This was a large qualitative study conducted in 2021 for 7 months from February to August. In this study, data were collected through in-depth semi-structured interviews with 70 non-clinical end-users in 22 public and six private hospitals of West Azerbaijan province in Iran. To analyze the data, the thematic analysis method was used. RESULTS The study results indicated that technical, human, cultural, managerial, and financial readiness are the most important factors affecting the implementation of EHRs in Iran. Among the mentioned factors, technical and human readiness were emphasized more by the users. Also, technical, organizational, human, and managerial factors were identified as factors influencing EHRs utilization, and technical and organizational factors had a stronger role in the system utilization. CONCLUSIONS According to the results, several factors influence EHR implementation and adequate utilization in Iran. To achieve the predetermined goals of this system, implementation issues and problems of using the system should be considered and solved.
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Affiliation(s)
- Hajar Abbasi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Bahlol Rahimi
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran.
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran.
| | - Mohamad Jebraeily
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Aynaz Nourani
- Health and Biomedical Informatics Research Center, Urmia University of Medical Sciences, Urmia, Iran
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
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Lin RH, kofi kujabi B. Addressing Challenges in the Development of Health Information Systems in The Gambia. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kruse G, Lopez-Carmen VA, Jensen A, Hardie L, Sequist TD. The Indian Health Service and American Indian/Alaska Native Health Outcomes. Annu Rev Public Health 2022; 43:559-576. [PMID: 35081315 DOI: 10.1146/annurev-publhealth-052620-103633] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Indian Health Service (IHS) has made huge strides in narrowing health disparities between American Indian and Alaska Native (AI/AN) populations and other racial and ethnic groups. Yet, health disparities experienced by AI/AN people persist, with deep historical roots combined with present-day challenges. Here we review the history of the IHS from colonization to the present-day system, highlight persistent disparities in AI/AN health and health care, and discuss six key present-day challenges: inadequate funding, limited human resources, challenges associated with transitioning services from federal to Tribal control through contracting and compacting, evolving federal and state programs, the need for culturally sensitive services, and the promise and challenges of health technology.
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Affiliation(s)
- Gina Kruse
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anpotowin Jensen
- School of Engineering, Stanford University, Stanford, California, USA
| | - Lakotah Hardie
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Thomas D Sequist
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Quality and Patient Experience, Massachusetts General Brigham, Somerville, Massachusetts, USA
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Faujdar DS, Singh T, Kaur M, Sahay S, Kumar R. Stakeholders' Perceptions of the Implementation of a Patient-Centric Digital Health Application for Primary Healthcare in India. Healthc Inform Res 2021; 27:315-324. [PMID: 34788912 PMCID: PMC8654332 DOI: 10.4258/hir.2021.27.4.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Health systems are shifting from traditional methods of healthcare delivery to delivery using digital applications. This change was introduced at a primary care centre in Chandigarh, India that served a marginalised population. After establishing the digital health system, we explored stakeholders' perceptions regarding its implementation. METHODS Ethnographic methods were used to explore stakeholders' perceptions regarding the implementation of the Integrated Health Information System for Primary Health Care (IHIS4PHC), which was developed as a patient-centric digital health application. Data were collected using focus group discussions and in-depth interviews. Participatory observations were made of day-to-day activities including outpatient visits, outreach field visits, and methods of health practice. The collected information was analysed using thematic coding. RESULTS Healthcare workers highlighted that working with the digital health system was initially arduous, but they later realised its usefulness, as the digital system made it easier to search records and generate reports, rapidly providing evidence to make decisions. Auxiliary nurse midwives reported that recording information on computers saved time when generating reports; however, systematic and mandatory data entry made recording tedious. Staff were apprehensive about the use of computer-based data for monitoring their work performance. Patients appreciated that their previous records were now available on the computer for easy retrieval. CONCLUSIONS The usefulness of the digital health application was appreciated by various primary healthcare stakeholders. Barriers persisted due to perceived needs for flexibility in delivering healthcare services, and apprehensions continued because of increased transparency, accountability, and dependence on computers and digital technicians.
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Affiliation(s)
- Dharamjeet Singh Faujdar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Huyser KR, Horse AJY, Kuhlemeier AA, Huyser MR. COVID-19 Pandemic and Indigenous Representation in Public Health Data. Am J Public Health 2021; 111:S208-S214. [PMID: 34709868 PMCID: PMC8561074 DOI: 10.2105/ajph.2021.306415] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/04/2022]
Abstract
Public Health 3.0 calls for the inclusion of new partners and novel data to bring systemic change to the US public health landscape. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has illuminated significant data gaps influenced by ongoing colonial legacies of racism and erasure. American Indian and Alaska Native (AI/AN) populations and communities have been disproportionately affected by incomplete public health data and by the COVID-19 pandemic itself. Our findings indicate that only 26 US states were able to calculate COVID-19‒related death rates for AI/AN populations. Given that 37 states have Indian Health Service locations, we argue that public health researchers and practitioners should have a far larger data set of aggregated public health information on AI/AN populations. Despite enormous obstacles, local Tribal facilities have created effective community responses to COVID-19 testing, tracking, and vaccine administration. Their knowledge can lead the way to a healthier nation. Federal and state governments and health agencies must learn to responsibly support Tribal efforts, collect data from AI/AN persons in partnership with Indian Health Service and Tribal governments, and communicate effectively with Tribal authorities to ensure Indigenous data sovereignty. (Am J Public Health. 2021;111(S3): S208-S214. https://doi.org/10.2105/AJPH.2021.306415).
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Affiliation(s)
- Kimberly R Huyser
- Kimberly R. Huyser is with the Department of Sociology at The University of British Columbia, Vancouver, BC, Canada. Aggie J. Yellow Horse is with the School of Social Transformation at the Arizona State University, Tempe. Alena A. Kuhlemeier is with the Department of Sociology at the University of New Mexico, Albuquerque. Michelle R. Huyser is with the Department of Surgery at Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Aggie J Yellow Horse
- Kimberly R. Huyser is with the Department of Sociology at The University of British Columbia, Vancouver, BC, Canada. Aggie J. Yellow Horse is with the School of Social Transformation at the Arizona State University, Tempe. Alena A. Kuhlemeier is with the Department of Sociology at the University of New Mexico, Albuquerque. Michelle R. Huyser is with the Department of Surgery at Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Alena A Kuhlemeier
- Kimberly R. Huyser is with the Department of Sociology at The University of British Columbia, Vancouver, BC, Canada. Aggie J. Yellow Horse is with the School of Social Transformation at the Arizona State University, Tempe. Alena A. Kuhlemeier is with the Department of Sociology at the University of New Mexico, Albuquerque. Michelle R. Huyser is with the Department of Surgery at Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Michelle R Huyser
- Kimberly R. Huyser is with the Department of Sociology at The University of British Columbia, Vancouver, BC, Canada. Aggie J. Yellow Horse is with the School of Social Transformation at the Arizona State University, Tempe. Alena A. Kuhlemeier is with the Department of Sociology at the University of New Mexico, Albuquerque. Michelle R. Huyser is with the Department of Surgery at Roswell Park Comprehensive Cancer Center, Buffalo, NY
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A model to measure self-assessed proficiency in electronic medical records: Validation using maturity survey data from Canadian community-based physicians. Int J Med Inform 2020; 141:104218. [PMID: 32574925 DOI: 10.1016/j.ijmedinf.2020.104218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Adoption of electronic medical records (EMRs) does not necessarily translate to proficiency -referred to here as EMR maturity. To realize the full benefit of wide scale EMR adoption, the focus must shift from adoption to advancing mature use. This calls for validated assessment models so that researchers, health system planners and digital health developers can better understand what contributes to maturity among physicians. This research aims to validate a measurement model for self-assessed EMR maturity among community-based physicians. METHODS As part of an Ontario government-funded EMR adoption program, the EMR Maturity Model for community-based practices was adapted from a hospital-based EMR maturity model. A survey instrument was developed on the foundation of the new model and revised by experts and stakeholders. Content validity, face validity and user acceptance were established before survey administration. Internal consistency and construct validity of the model were tested after survey data were collected. Finally, physicians' comments collected via the survey were qualitatively analyzed to provide additional insights that can be applied to refinement of the model and survey. RESULTS As of August 1, 2019, 1588 physicians completed the survey. Ordinal alpha tests for reliability and content validity yielded an alpha value of 0.86 across all key measures specifically associated with maturity. Among most of these, there was a pattern of weak to moderate significant (p < .0001) positive Spearman inter-correlations. One factor was extracted for items measuring dimensions of maturity and all factor loadings of the key measures were greater than 0.40. The fit of the one-factor model was moderately adequate. This indicates the model is valid and reliable, with consistency across key measures for measuring one factor: maturity. CONCLUSIONS This is the first known validated model published in English that measures EMR maturity among community-based physicians. While the model is shown to be valid and reliable statistically and qualitative analysis supports this, there is room for improvement. Both the statistical analysis and portions of the qualitative analysis suggest areas of exploration to strengthen the model and survey. Future efforts will include refining the survey to improve user interface and accrue further data, as the sample to date is insufficient for generalizability.
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Dahleez KA, Bader I, Aboramadan M. E-health system characteristics, medical performance and healthcare quality at UNRWA-Palestine health centers. JOURNAL OF ENTERPRISE INFORMATION MANAGEMENT 2020. [DOI: 10.1108/jeim-01-2019-0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.Design/methodology/approachThis study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.FindingsStudy concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.Research limitations/implicationsNoteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.Practical implicationsManagement should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.Originality/valueThe importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.
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Farzandipour M, Meidani Z, Nabovati E, Sadeqi Jabali M, Dehghan Banadaki R. Technical requirements framework of hospital information systems: design and evaluation. BMC Med Inform Decis Mak 2020; 20:61. [PMID: 32245499 PMCID: PMC7119017 DOI: 10.1186/s12911-020-1076-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS. METHODS The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements. RESULTS The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8% of the HIS programs, system architecture in 65.5%, security service in 72.4% and system response time in 76.3%. CONCLUSIONS A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions.
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Affiliation(s)
- Mehrdad Farzandipour
- Research Centre for Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Meidani
- Research Centre for Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Ehsan Nabovati
- Research Centre for Health Information Management, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Monireh Sadeqi Jabali
- Department of Health Information Management & Technology, Kashan University of Medical Sciences, Kashan, Iran
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O’Donnell A, Kaner E, Shaw C, Haighton C. Primary care physicians' attitudes to the adoption of electronic medical records: a systematic review and evidence synthesis using the clinical adoption framework. BMC Med Inform Decis Mak 2018; 18:101. [PMID: 30424758 PMCID: PMC6234586 DOI: 10.1186/s12911-018-0703-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 09/25/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recent decades have seen rapid growth in the implementation of Electronic Medical Records (EMRs) in healthcare settings in both developed regions as well as low and middle income countries. Yet despite substantial investment, the implementation of EMRs in some primary care systems has lagged behind other settings, with piecemeal adoption of EMR functionality by primary care physicians (PCPs) themselves. We aimed to review and synthesise international literature on the attitudes of PCPs to EMR adoption using the Clinical Adoption (CA) Framework. METHODS MEDLINE, PsycINFO, and EMBASE were searched from 1st January 1996 to 1st August 2017 for studies investigating PCP attitudes towards EMR adoption. Papers were screened by two independent reviewers, and eligible studies selected for further assessment. Findings were categorised against the CA Framework and the quality of studies assessed against one of three appropriate tools. RESULTS Out of 2263 potential articles, 33 were included, based in North and South America, Europe, Middle East and Hong Kong. Concerns about the accessibility, reliability and EMR utility exerted an adverse influence on PCPs' attitudes to adoption. However many were positive about their potential to improve clinical productivity, patient safety and care quality. Younger, computer-literate PCPs, based in large/multi-group practices, were more likely to be positively inclined to EMR use than older physicians, less-skilled in technology use, based in solo practices. Adequate training, policies and procedures favourably impacted on PCPs' views on EMR implementation. Financial factors were common system level influencers shaping EMR adoption, from start-up costs to the resources required by ongoing use. CONCLUSIONS By using the CA Framework to synthesise the evidence, we identified a linked series of factors influencing PCPs attitudes to EMR adoption. Findings underline the need to involve end-users in future implementation programmes from the outset, to avoid the development of an EMR which is neither feasible nor acceptable for use in practice. TRIAL REGISTRATION PROSPERO CRD42016038790 .
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Affiliation(s)
- Amy O’Donnell
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Eileen Kaner
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Caroline Shaw
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE7 7XA UK
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Yang CY, Lo YS, Chen RJ, Liu CT. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation. JMIR Med Inform 2018; 6:e6. [PMID: 29351893 PMCID: PMC5797291 DOI: 10.2196/medinform.9064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required.
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Affiliation(s)
- Cheng-Yi Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Medical Informatics, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Sheng Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Tsai Liu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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14
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Information and communication technologies in primary healthcare facilities in Egypt. Prim Health Care Res Dev 2017; 19:88-95. [PMID: 28786373 DOI: 10.1017/s1463423617000470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The health sector has always relied on technologies. According to World Health Organization, they form the backbone of the services to prevent, diagnose, and treat illness and disease. It is increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system. Aim of the study This was to assess the current situation of information and communication technologies (ICTs) in primary healthcare in the terms of describing and classifying the existing work, identify gaps and exploring the personal experiences and the challenges of ICTs application in the primary healthcare. Subjects and methods A mixed research method in the form of sequential explanatory design was applied. In the quantitative phase a cross-sectional study was conducted among 172 family physicians using a predesigned questionnaire. Followed by qualitative data collection among 35 participants through focused group discussions. RESULTS Nearly half of the physicians have ICTs in their work and they were trained on it. None of them developed a community-based research using ICTs technology. Training on ICTs showed a statistically significant difference regarding the availability and the type of ICTs present in the workplace (P<0.05). Focused group discussion revealed that the majority of the participants believe that there is poor commitment of policymaker toward ICTs utilization in the primary care. Nearly 97% thinks that there is insufficient budget allocated for ICTs utilization in the workplace. Almost 88% of the participants demanded more incentives for ICTs users than non-user at the workplace. CONCLUSIONS ICTs resources are underutilized by health information professionals. Lack of funds, risk of instability of the electric supply and lack of incentives for ICTs users were the most common barriers to ICTs implementation thus a steady steps toward budget allocation and continuous training is needed.
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15
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Stanczyk NE, Crutzen R, Sewuster N, Schotanus E, Mulders M, Cremers HP. Differences in Sociocognitive Beliefs between Involved and Noninvolved Employees during the Implementation of an Electronic Health Record System. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1c. [PMID: 28566986 PMCID: PMC5430131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Electronic health records (EHRs) can improve quality and efficiency in patient care. However, the intention to work with such a new system is often relatively low among employees because the work processes of the healthcare organization may change. Involving employees in an EHR implementation may increase their beliefs and perceived capabilities concerning the new system. The current study aimed to assess the role of involvement and its effects on sociocognitive beliefs regarding the implementation of a new EHR system. METHODS The study was performed in June 2015 among all eligible employees of a hospital in the Netherlands. Both involved and noninvolved employees were invited to complete a paper-based questionnaire concerning their sociocognitive beliefs (i.e., attitude, social influence, self-efficacy, and intention) related to the EHR implementation. Independent sample t-tests were used to assess potential differences in sociocognitive beliefs between employees who were involved in the implementation process and those who were not. Effect sizes (Cohen's d) were calculated to indicate the standardized difference between the means. RESULTS A total of 359 participants completed the paper-based questionnaire and were included in the analyses. Involved employees (n = 94) reported significantly higher levels of attitude (p < .001, d = .62), perceived self-efficacy (p = .01, d = .31), social support (p < .001, d = .68), and a higher intention to work with the new EHR system (p < .001, d = .60), compared with the group of employees who were not involved in the implementation process (n = 265). CONCLUSION Involving employees during an EHR implementation appears to enhance employees' sociocognitive beliefs and increases their intention to work with the new system.
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16
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Charney P. Computer Technology and the Nutrition Support Professional: Make It Work For You! Nutr Clin Pract 2017; 22:421-7. [PMID: 17644696 DOI: 10.1177/0115426507022004421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Healthcare professionals caring for patients receiving enteral and parenteral nutrition (PN) are faced with the need to develop and expand their technologic skills. Patients and their caregivers are finding information from the Internet that healthcare professionals are then tasked with evaluating for accuracy and veracity. Healthcare professionals themselves must be able to rapidly find information to answer clinical questions that arise during daily practice. Information-seeking skills must be well developed in order to find information from the Internet, as well as in the professional literature. Such skills include the ability to formulate a search strategy that limits extraneous results as much as possible yet ensures that relevant results are not missed. In addition, electronic health records are being implemented in many facilities now, with a national goal of an electronic health record in place by 2014. Clinicians must be involved with implementation at all stages, including planning, purchasing, implementing, and evaluating an electronic system. Electronic health records can include very sophisticated components that provide for computerized physician order entry (CPOE) and decision support. Nutrition support must be an integral part of these systems. This paper provides some background information on the Internet and the World Wide Web, along with strategies to find information using search engines. Information is also provided on the use of MEDLINE to search medical literature. Finally, a brief overview of the electronic health record is provided, with suggestions for involvement by nutrition support clinicians in implementation of electronic health records in the workplace.
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Affiliation(s)
- Pamela Charney
- Nutrition Sciences, 305B Raitt Hall, University of Washington, Seattle, WA 98095, USA.
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17
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Kenny G, O’Connor Y, Eze E, Ndibuagu E, Heavin C. A Ground-Up Approach to mHealth in Nigeria: A Study of Primary Healthcare Workers’ Attitude to mHealth Adoption. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.procs.2017.11.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Mohd Salleh MI, Zakaria N, Abdullah R. The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia. J Infect Public Health 2016; 9:698-707. [PMID: 27659115 DOI: 10.1016/j.jiph.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/18/2016] [Accepted: 09/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. METHODS Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. RESULTS AND CONCLUSIONS Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity.
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Affiliation(s)
- Mohd Idzwan Mohd Salleh
- School of Computer Sciences, Universiti Sains Malaysia, Malaysia; Faculty of Information Management, Universiti Teknologi MARA, Malaysia.
| | - Nasriah Zakaria
- School of Computer Sciences, Universiti Sains Malaysia, Malaysia; Medical Informatics and e-Learning Unit, Medical Education Department, College of Medicine, King Saud University, Saudi Arabia; The Research Chair of Health Informatics and Promotion, King Saud University, Saudi Arabia
| | - Rosni Abdullah
- School of Computer Sciences, Universiti Sains Malaysia, Malaysia; National Advanced IPv6 Centre of Excellence, Universiti Sains Malaysia, Malaysia
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19
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Kruse GR, Hays H, Orav EJ, Palan M, Sequist TD. Meaningful Use of the Indian Health Service Electronic Health Record. Health Serv Res 2016; 52:1349-1363. [PMID: 27461978 DOI: 10.1111/1475-6773.12531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. DATA SOURCE/STUDY SETTING A total of 333 Indian Health Service physicians (55 percent response rate) in August 2012. STUDY DESIGN Cross-sectional. DATA COLLECTION The survey assessed routine use of EHR functionalities, perceived usefulness, and barriers to adoption. PRINCIPAL FINDINGS Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient-physician interactions (45 percent). Primary care specialty and time using the EHR were positively associated with use of EHR functionalities, while perceived productivity loss was negatively associated. CONCLUSIONS Significant opportunities exist to increase use of EHR functionalities and preserve physician-patient interactions and productivity in a resource-limited environment.
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Affiliation(s)
| | | | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Thomas D Sequist
- Partners HealthCare System, Boston, MA.,Department of Health Care Policy, Harvard Medical School, Boston, MA
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20
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Kim MK, Park JH. Identifying and prioritizing critical factors for promoting the implementation and usage of big data in healthcare. INFORMATION DEVELOPMENT 2016. [DOI: 10.1177/0266666916652671] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Big data is expected to provide many benefits to healthcare organizations through cost reduction, disease prediction, and patient care improvement. Big data in healthcare at a nascent stage faces many challenges in satisfying expectations. This study investigates factors for promoting the implementation and usage of big data in healthcare in Korea, using an analytical hierarchy process (AHP). We established a research framework that considers four domains and 15 factors. We collected data by a survey of experts engaged in big data and healthcare IT. The results show that data and organization have greater impacts than technology and support domains. Organizational analytics capability, data quality, data privacy and security, organizational application capability, data standardization, and data experts are the most important factors for promoting the implementation and usage of big data in healthcare. The study presents the implications in terms of the policies and ecosystem for countries, including Korea, which intend to activate big data in healthcare.
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Affiliation(s)
- Moon-Koo Kim
- Korea Advanced Institute of Science and Technology (KAIST); Electronics and Telecommunications Research Institute (ETRI), Korea
| | - Jong-Hyun Park
- Electronics and Telecommunications Research Institute (ETRI), Korea
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21
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Hiratsuka VY, Smith JJ, Norman SM, Manson SM, Dillard DA. Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care. Int J Circumpolar Health 2015; 74:28315. [PMID: 26519359 PMCID: PMC4627941 DOI: 10.3402/ijch.v74.28315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs). OBJECTIVES (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with guideline concordant management and (b) to assess whether management varied by patient and provider factors. RESEARCH DESIGN Secondary analysis of electronic and paper medical record information of 400 AN/AIs. MEASURES Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors. RESULTS A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management. CONCLUSIONS Most AN/AIs screening positive for depression received initial guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.
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Affiliation(s)
| | - Julia J Smith
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Sara M Norman
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Denise A Dillard
- Research Department, Southcentral Foundation, Anchorage, AK, USA;
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22
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Reilley B, Leston J, Tulloch S, Neel L, Galope M, Taylor M. Implementation of National HIV Screening Recommendations in the Indian Health Service. J Int Assoc Provid AIDS Care 2015; 14:291-4. [PMID: 25656861 DOI: 10.1177/2325957415570744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Indian Health Service (IHS), a federal agency, provides direct patient care to an estimated 1.9 million American Indian/Alaska Native patients across a large and decentralized network of health facilities. The IHS sought to implement HIV screening of adults and adolescents per national recommendations. The IHS facilities received technical support such as electronic clinical reminders (ECRs) and sample HIV-testing policies. PURPOSE To determine what facility-wide policy and practices were associated with high HIV screening rates. METHODS Survey of clinical directors of 61 federal health facilities on use of ECRs, testing policies/standing orders, and other factors associated with HIV screening. These results were correlated with HIV screening performance results for each facility as derived from the IHS national database. RESULTS A total of 51 (84%) of 61 facilities were interviewed. In univariate analysis, factors that were correlated with higher rates of HIV screening were having an HIV screening standing order (unadjusted odds ratio [UOR] 8.7, 95% confidence interval [CI] 2.0-37.3), sexually transmitted disease (STD) screening standing order (UOR 5, CI 1.1-21.7), having an HIV ECR in place for a year or longer (UOR 10.2, CI 2.8-37.5), and inclusion of both providers and nurses in offering HIV screening (UOR 4.8, CI 1.4-16.7). In multivariate analysis, ECRs (adjusted odds ratio [AOR] 9.1, 95% CI 1.8-45.1) and STD standing orders (AOR 7.4, 95% CI 1.1-51.0) remained significantly associated with higher HIV screening. CONCLUSION Policy and practice interventions such as ECRs and standing order/testing policies and delegation of screening are correlated with high HIV screening, are scalable across health networks, and will be used for improving other infectious disease screening indicators in such as STD and hepatitis C.
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Affiliation(s)
- Brigg Reilley
- Indian Health Service Division of Epidemiology and Disease Prevention, Albuquerque, NM, USA
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Scott Tulloch
- Centers for Disease Control and Prevention, CDC/NCHHSTP/DSTDP, Phoenix, AZ, USA
| | - Lisa Neel
- Indian Health Service, Rockville, MD, USA
| | | | - Melanie Taylor
- Centers for Disease Control and Prevention, CDC/NCHHSTP/DSTDP, Phoenix, AZ, USA
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23
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Robinson RF, Dillard DA, Hiratsuka VY, Smith JJ, Tierney S, Avey JP, Buchwald DS. Formative Evaluation to Assess Communication Technology Access and Health Communication Preferences of Alaska Native People. INTERNATIONAL JOURNAL OF INDIGENOUS HEALTH 2015; 10:88-101. [PMID: 27169131 DOI: 10.18357/ijih.102201515042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Information technology can improve the quality, safety, and efficiency of healthcare delivery by improving provider and patient access to health information. We conducted a nonrandomized, cross-sectional, self-report survey to determine whether Alaska Native and American Indian (AN/AI) people have access to the health communication technologies available through a patient-centered medical home. METHODS In 2011, we administered a self-report survey in an urban, tribally owned and operated primary care center serving AN/AI adults. Patients in the center's waiting rooms completed the survey on paper; center staff completed it electronically. RESULTS Approximately 98% (n = 654) of respondents reported computer access, 97% (n = 650) email access, and 94% (n = 631) mobile phone use. Among mobile phone users, 60% had Internet access through their phones. Rates of computer access (p = .011) and email use (p = .005) were higher among women than men, but we found no significant gender difference in mobile phone access to the Internet or text messaging. Respondents in the oldest age category (65-80 years of age) were significantly less likely to anticipate using the Internet to schedule appointments, refill medications, or communicate with their health care providers (all p < .001). CONCLUSION Information on use of health communication technologies enables administrators to deploy these technologies more efficiently to address health concerns in AN/AI communities. Our results will drive future research on health communication for chronic disease screening and health management.
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24
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El Mahalli A. Electronic health records: Use and barriers among physicians in eastern province of Saudi Arabia. SAUDI JOURNAL FOR HEALTH SCIENCES 2015. [DOI: 10.4103/2278-0521.151407] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jauhari S, Rizvi SAM. An Indian eye to personalized medicine. Comput Biol Med 2014; 59:211-220. [PMID: 25128302 DOI: 10.1016/j.compbiomed.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 12/29/2022]
Abstract
Acknowledging the successful sequencing of the human genome and the valuable insights it has rendered, genetic drafting of non-human organisms can further enhance the understanding of modern biology. The price of sequencing technology has plummeted with time, and there is a noticeable enhancement in its implementation and recurrent usage. Sequenced genome information can be contained in a microarray chip, and then processed by a computer system for inferring analytics and predictions. Specifically, smart cards have been significantly applicable to assimilate and retrieve complex data, with ease and implicit mobility. Herein, we propose "The G-Card", a development with respect to the prevalent smart card, and an extension to the Electronic Health Record (EHR), that will hold the genome sequence of an individual, so that the medical practitioner can better investigate irregularities in a patient's health and hence recommend a precise prognosis.
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Affiliation(s)
- Shaurya Jauhari
- Department of Computer Science, Jamia Millia Islamia, New Delhi, India.
| | - S A M Rizvi
- Department of Computer Science, Jamia Millia Islamia, New Delhi, India.
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26
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Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform 2014; 83:779-96. [PMID: 25085286 DOI: 10.1016/j.ijmedinf.2014.06.011] [Citation(s) in RCA: 203] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation. MATERIALS AND METHODS A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues. RESULTS A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR. LIMITATIONS This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period. CONCLUSION This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations.
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Affiliation(s)
- Lemai Nguyen
- School of Information and Business Analytics, Deakin University, Melbourne, Australia.
| | - Emilia Bellucci
- School of Information and Business Analytics, Deakin University, Melbourne, Australia
| | - Linh Thuy Nguyen
- School of Information and Business Analytics, Deakin University, Melbourne, Australia
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27
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Veazie M, Ayala C, Schieb L, Dai S, Henderson JA, Cho P. Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009. Am J Public Health 2014; 104 Suppl 3:S359-67. [PMID: 24754556 PMCID: PMC4035888 DOI: 10.2105/ajph.2013.301715] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated heart disease death rates among American Indians and Alaska Natives (AI/ANs) and Whites after improving identification of AI/AN populations. METHODS Indian Health Service (IHS) registration data were linked to the National Death Index for 1990 to 2009 to identify deaths among AI/AN persons aged 35 years and older with heart disease listed as the underlying cause of death (UCOD) or 1 of multiple causes of death (MCOD). We restricted analyses to IHS Contract Health Service Delivery Areas and to non-Hispanic populations. RESULTS Heart disease death rates were higher among AI/AN persons than Whites from 1999 to 2009 (1.21 times for UCOD, 1.30 times for MCOD). Disparities were highest in younger age groups and in the Northern Plains, but lowest in the East and Southwest. In AI/AN persons, MCOD rates were 84% higher than UCOD rates. From 1990 to 2009, UCOD rates declined among Whites, but only declined significantly among AI/AN persons after 2003. CONCLUSIONS Analysis with improved race identification indicated that AI/AN populations experienced higher heart disease death rates than Whites. Better prevention and more effective care of heart disease is needed for AI/AN populations.
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Affiliation(s)
- Mark Veazie
- Mark Veazie is with the Phoenix Area Indian Health Service, Flagstaff, AZ. Carma Ayala and Linda Schieb are with the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Shifan Dai is with the Division for Nutrition and Physical Activity, Centers for Disease Control and Prevention. Jeffrey A. Henderson is with the Black Hills Center for American Indian Health, Rapid City, SD. Pyone Cho is with the Division of Diabetes Translation, Centers for Disease Control and Prevention
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28
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Lakbala P, Dindarloo K. Physicians' perception and attitude toward electronic medical record. SPRINGERPLUS 2014; 3:63. [PMID: 24516790 PMCID: PMC3918096 DOI: 10.1186/2193-1801-3-63] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022]
Abstract
Implementation of an electronic medical record (EMR) system increases efficiency of health services, quality of care and patient satisfaction. Successful implementation of EMRs depends on many factors. The path to quality improvement and financial gain with EMRs lies in getting the greatest number of Physicians to use the system. The main objective of this research is to explore physicians, attitude and perceptions of importance EMRs function, anticipated utilization of EMR functions and also issue impact EMRs. The cross-sectional study was conducted on 133 specialist physicians of three teaching hospitals of Hormozgan Medical Sciences University. The most important finding in this study was the Entry/Display of Diagnoses and Medications (96.3%) and Prescription Alerts drug-drug, allergy and dose checking and formulary management (96.2%) were of greatest importance to respondents. Nuclear medicine, Time trended Clinical Data Display, decision support capabilities, and medical management reporting generated percentage suggesting less than weekly usage. Only a small number of respondents addressed physicians' resistance in compare to another issues impact on EMRs. Understanding physician perceptions and attitude will allow for the development of targeted education to demonstrate the advantages and implementation of EMRs in further and improve physician perceptions of EMRs.
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Affiliation(s)
- Parvin Lakbala
- Health information management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Kavoos Dindarloo
- Hormozgan Environmental and Occupational Health Engineering Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Friedman DJ, Parrish RG, Ross DA. Electronic health records and US public health: current realities and future promise. Am J Public Health 2013; 103:1560-7. [PMID: 23865646 DOI: 10.2105/ajph.2013.301220] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Electronic health records (EHRs) could contribute to improving population health in the United States. Realizing this potential will require understanding what EHRs can realistically offer to efforts to improve population health, the requirements for obtaining useful information from EHRs, and a plan for addressing these requirements. Potential contributions of EHRs to improving population health include better understanding of the level and distribution of disease, function, and well-being within populations. Requirements are improved population coverage of EHRs, standardized EHR content and reporting methods, and adequate legal authority for using EHRs, particularly for population health. A collaborative national effort to address the most pressing prerequisites for and barriers to the use of EHRs for improving population health is needed to realize the EHR's potential.
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Onders R, Spillane J, Reilley B, Leston J. Use of electronic clinical reminders to increase preventive screenings in a primary care setting: blueprint from a successful process in Kodiak, Alaska. J Prim Care Community Health 2013; 5:50-4. [PMID: 24327588 DOI: 10.1177/2150131913496116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The Kodiak Area Native Association (KANA) provides primary health care in Kodiak, Alaska and 6 outlying villages. KANA sought to actively improve key preventive screening rates for its patients. METHODS KANA adopted an electronic health record in 2008 and deployed national clinical reminders from the Indian Health Service for 5 key preventive screenings: tobacco use, alcohol use, depression, intimate partner violence, and a comprehensive cardiovascular exam. Clinical reminders were deployed in a 5-step process: (a) establish clinical demand, (b) pilot test reminder, (c) expand reminder to all providers, (d) measure outcomes and share results, and (e) delegate clinical reminder follow-up (primarily to nurses). RESULTS Data from 2007-2011 show screening rates for all 5 measures improved considerably, to levels significantly above the national average for Indian Health Service facilities. CONCLUSIONS Clinical reminders have been a key part of a multistep process to improve screening for depression, tobacco cessation, intimate partner violence, alcohol use, and cardiovascular disease. If deployed correctly, reminders are valuable tools in identifying patients who are overdue for preventive health screenings.
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Pfoh ER, Abramson E, Zandieh S, Edwards A, Kaushal R. Satisfaction after the transition between electronic health record systems at six ambulatory practices. J Eval Clin Pract 2012; 18:1133-9. [PMID: 21883714 DOI: 10.1111/j.1365-2753.2011.01756.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Early adopters of electronic health records (EHRs) are transitioning from older to newer EHRs to satisfy meaningful use requirements. Facilitators and barriers to satisfaction after transitioning are important to understand as provider satisfaction is linked with improvement in health care. METHOD We conducted a cross-sectional survey of providers who transitioned from an older to a newer EHR at six academic, urban ambulatory medical practices. A novel survey was developed to assess: (1) satisfaction with the EHR implementation; (2) patterns of information technology use; (3) work perceptions; (4) methods for completing clinical tasks; and (5) demographic characteristics. We analysed the results using bivariate and multivariate analyses. RESULTS The response rate was 64% (n = 197). A small majority were satisfied with the new EHR (64%, n = 120). Providers who reported satisfaction with overall quality of work life, their workload and the transition were more likely to be satisfied with the new EHR (P < 0.01). Providers who reported using the Internet at least daily were also more likely to be satisfied with the new EHR (P < 0.05). In a multivariate model, satisfaction with the transition was a strong predictor of satisfaction with the new EHR (P < 0.01). Barriers to satisfaction include dissatisfaction with: maintaining problem and medication lists, tracking health maintenance information, referring to clinical practice guidelines and ordering laboratory and radiology tests (P < 0.01). CONCLUSION This study provides groundwork for understanding the facilitators and barriers to provider satisfaction after the transition between EHRs and provides insight into areas requiring attention by entities undergoing similar transitions.
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Affiliation(s)
- Elizabeth R Pfoh
- Division of Quality and Medical Informatics, Weill Cornell Medical College, New York, NY, USA.
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Montague E, Perchonok J. Health and wellness technology use by historically underserved health consumers: systematic review. J Med Internet Res 2012; 14:e78. [PMID: 22652979 PMCID: PMC3799608 DOI: 10.2196/jmir.2095] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 03/28/2012] [Accepted: 04/25/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature. OBJECTIVE To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes. METHODS We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health). RESULTS A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology. CONCLUSIONS While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information technology should be used more for chronic diseases and disease management, as it is an innovative way to provide holistic care and reminders to otherwise underserved populations. Additionally, design processes should be stated regularly so that best practices can be created. Finally, the evaluation process should be standardized to create a benchmark for culturally informed health information technology.
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Affiliation(s)
- Enid Montague
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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Dünnebeil S, Sunyaev A, Blohm I, Leimeister JM, Krcmar H. Determinants of physicians' technology acceptance for e-health in ambulatory care. Int J Med Inform 2012; 81:746-60. [PMID: 22397989 DOI: 10.1016/j.ijmedinf.2012.02.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 01/13/2012] [Accepted: 02/05/2012] [Indexed: 01/08/2023]
Abstract
BACKGROUND Germany is introducing a nation-wide telemedicine infrastructure that enables electronic health services. The project is facing massive resistance from German physicians, which has led to a delay of more than five years. Little is known about the actual burdens and drivers for adoption of e-health innovations by physicians. OBJECTIVE Based on a quantitative study of German physicians who participated in the national testbed for telemedicine, this article extends existing technology acceptance models (TAM) for electronic health (e-health) in ambulatory care settings and elaborates on determinants of importance to physicians in their decision to use e-health applications. METHODS This study explores the opinions, attitudes, and knowledge of physicians in ambulatory care to find drivers for technology acceptance in terms of information technology (IT) utilization, process and security orientation, standardization, communication, documentation and general working patterns. We identified variables within the TAM constructs used in e-health research that have the strongest evidence to determine the intention to use e-health applications. RESULTS The partial least squares (PLS) regression model from data of 117 physicians showed that the perceived importance of standardization and the perceived importance of the current IT utilization (p<0.01) were the most significant drivers for accepting electronic health services (EHS) in their practice. Significant influence (p<0.05) was shown for the perceived importance of information security and process orientation as well as the documentation intensity and the e-health-related knowledge. CONCLUSIONS This study extends work gleaned from technology acceptance studies in healthcare by investigating factors which influence perceived usefulness and perceived ease of use of e-health services. Based on these empirical findings, we derive implications for the design and introduction of e-health services including suggestions for introducing the topic to physicians in ambulatory care and incentive structures for using e-health.
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Affiliation(s)
- Sebastian Dünnebeil
- Department of Informatics, Technical University of Munich, Bolzmannstrasse 3, 85748 Garching bei München, Germany
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Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: an assessment of system use and the impact of large-scale disruptions. Int J Med Inform 2012; 81:244-56. [PMID: 22361158 DOI: 10.1016/j.ijmedinf.2012.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE System use is a key criterion of success in an electronic medical record (EMR) implementation, and there is little research on long-term use of systems following implementation. The aim of the paper was to describe the development, implementation and use of iSanté, Haiti's national HIV care and treatment EMR. METHODS To build a picture of the history of iSanté, we interviewed 11 staff involved with the development and implementation of the EMR, and reviewed organization records. Data entry and report use were ascertained by querying the central patient database. RESULTS By the end of 2010 there were 67 sites with iSanté installed, and the scope of the system had been expanded to include primary care and obstetrics and gynecology. New functionality includes data forms specific to subpopulations, the ability to transfer patient records among clinics, and integration with an electronic laboratory system. We observed fluctuations in use over time, with substantial reductions in the number of active sites during times of large-scale disruptions in Haiti. A surge in report use following the January 2010 earthquake suggests that clinics found the EMR to be a valuable source of data during the recovery phase. CONCLUSION There is real potential for EMRs in developing countries to improve clinical practice and make data available for efficient reporting, quality improvement and other population health uses. An approach of continuous system improvement, combined with regular assessments of use, is necessary for achieving an effective, national implementation of a standardized EMR. We have achieved successes in terms of rolling out new functionality and expanding to new sites, but more work remains to be done to improve perceptions of data quality and increase use of population data for accurate and timely reporting.
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Holanda AA, do Carmo e Sá HL, Vieira APGF, Catrib AMF. Use and Satisfaction with Electronic Health Record by Primary Care Physicians in a Health District in Brazil. J Med Syst 2011; 36:3141-9. [DOI: 10.1007/s10916-011-9801-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 10/25/2011] [Indexed: 11/25/2022]
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Sequist TD, Cullen T, Acton KJ. Indian Health Service Innovations Have Helped Reduce Health Disparities Affecting American Indian And Alaska Native People. Health Aff (Millwood) 2011; 30:1965-73. [DOI: 10.1377/hlthaff.2011.0630] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas D. Sequist
- Thomas D. Sequist is an associate professor of medicine and health care policy at Harvard Medical School and Brigham and Women’s Hospital, in Boston, Massachusetts
| | - Theresa Cullen
- Theresa Cullen is the director of health domain information technology at the Department of Health and Human Services in Washington, D.C
| | - Kelly J. Acton
- Kelly J. Acton is the deputy regional health administrator for Department of Health and Human Services Region IX, in San Francisco, California
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Learning From Within to Ensure a Successful Implementation of an Electronic Health Record. Comput Inform Nurs 2011; 29:468-77; quiz 478-9. [DOI: 10.1097/ncn.0b013e3181fc3fc7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fleming NS, Culler SD, McCorkle R, Becker ER, Ballard DJ. The financial and nonfinancial costs of implementing electronic health records in primary care practices. Health Aff (Millwood) 2011; 30:481-9. [PMID: 21383367 DOI: 10.1377/hlthaff.2010.0768] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters.
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Affiliation(s)
- Neil S Fleming
- Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas, USA.
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Houser S, Au D, Weech-Maldonado R. The impact of geography on hospital electronic health records implementation in alabama: implications for meaningful use. Appl Clin Inform 2011; 2:270-83. [PMID: 23616876 PMCID: PMC3631931 DOI: 10.4338/aci-2011-01-ra-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/19/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given relatively less favorable health outcomes in rural Alabama, electronic health records (EHRs) have an even greater potential to improve quality and alleviate disparities if meaningfully used. OBJECTIVES We examined rural-urban differences as it pertained to perceived barriers, benefits, and motivating factors of EHR implementation. METHODS We used multivariate logistic models to analyze data collected from a state-wide, self-completed survey of health information management directors in Alabama hospitals. RESULTS Findings from our analyses indicate that fewer rural hospitals (8%) have implemented EHRs as compared with urban hospitals (18%). Rural hospitals were 71% less likely to consider reduction in costs as a benefit of EHRs (OR = 0.29), and were 75% less likely to consider lack of structured technology as a challenge factor of EHR implementation (OR = 0.25). CONCLUSION Promotion of EHRs in rural areas is challenging but necessary. Understanding perceived barriers and motivating factors of EHR implementation among rural hospitals can inform policy decisions, especially in light of recent meaningful use initiatives.
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Affiliation(s)
| | - D. Au
- University of Alabama at Birmingham
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Holroyd-Leduc JM, Lorenzetti D, Straus SE, Sykes L, Quan H. The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence. J Am Med Inform Assoc 2011; 18:732-7. [PMID: 21659445 DOI: 10.1136/amiajnl-2010-000019] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The electronic medical record (EMR)/electronic health record (EHR) is becoming an integral component of many primary-care outpatient practices. Before implementing an EMR/EHR system, primary-care practices should have an understanding of the potential benefits and limitations. OBJECTIVE The objective of this study was to systematically review the recent literature around the impact of the EMR/EHR within primary-care outpatient practices. MATERIALS AND METHODS Searches of Medline, EMBASE, CINAHL, ABI Inform, and Cochrane Library were conducted to identify articles published between January 1998 and January 2010. The gray literature and reference lists of included articles were also searched. 30 studies met inclusion criteria. RESULTS AND DISCUSSION The EMR/EHR appears to have structural and process benefits, but the impact on clinical outcomes is less clear. Using Donabedian's framework, five articles focused on the impact on healthcare structure, 21 explored healthcare process issues, and four focused on health-related outcomes.
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Sequist TD, Cullen T, Bernard K, Shaykevich S, Orav EJ, Ayanian JZ. Trends in quality of care and barriers to improvement in the Indian Health Service. J Gen Intern Med 2011; 26:480-6. [PMID: 21132462 PMCID: PMC3077488 DOI: 10.1007/s11606-010-1594-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/15/2010] [Accepted: 11/17/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although Native Americans experience substantial disparities in health outcomes, little information is available regarding healthcare delivery for this population. OBJECTIVE To analyze trends in ambulatory quality of care and physician reports of barriers to quality improvement within the Indian Health Service (IHS). DESIGN Longitudinal analysis of clinical performance from 2002 to 2006 within the IHS, and a physician survey in 2007. PARTICIPANTS Adult patients cared for within the IHS and 740 federally employed physicians within the IHS. MAIN MEASURES Clinical performance for 12 measures of ambulatory care within the IHS; as well as physician reports of ability to access needed health services and use of quality improvement strategies. We examined the correlation between physician reports of access to mammography and clinical performance of breast cancer screening. A similar correlation was analyzed for diabetic retinopathy screening. KEY RESULTS Clinical performance significantly improved for 10 of the 12 measures from 2002 to 2006, including adult immunizations, cholesterol testing, and measures of blood pressure and cholesterol control for diabetes and cardiovascular disease. Breast cancer screening rates decreased (44% to 40%, p = 0.002), while screening rates for diabetic retinopathy remained constant (51%). Fewer than half of responding primary care physicians reported adequate access to high-quality specialists (29%), non-emergency hospital admission (37%), high-quality imaging services (32%), and high-quality outpatient mental health services (16%). Breast cancer screening rates were higher at sites with higher rates of physicians reporting routine access to mammography compared to sites with lower rates of physicians reporting such access (46% vs. 35%, ρ = 0.27, p = 0.04). Most physicians reported using patient registries and decision support tools to improve patient care. CONCLUSIONS Quality of care has improved within the IHS for many services, however performance in specific areas may be limited by access to essential resources.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
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Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 2011; 9:46. [PMID: 21524315 PMCID: PMC3103434 DOI: 10.1186/1741-7015-9-46] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 04/28/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. METHODS Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. RESULTS Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities. CONCLUSIONS This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.
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Jahanbakhsh M, Tavakoli N, Mokhtari H. Challenges of EHR implementation and related guidelines in Isfahan. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.procs.2010.12.194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Carroll M, Cullen T, Ferguson S, Hogge N, Horton M, Kokesh J. Innovation in Indian healthcare: using health information technology to achieve health equity for American Indian and Alaska Native populations. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2011; 8:1d. [PMID: 21307987 PMCID: PMC3035828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The US Indian health system utilizes a diverse range of health information technology and innovative tools to enhance health service delivery for American Indians and Alaska Natives. This article provides an overview of efforts and experience using such tools to achieve health equity for American Indian and Alaska Native communities. Specific attention is given to the Indian Health Service Electronic Health Record and to two examples of telehealth innovation.
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Castillo VH, Martínez-García AI, Pulido JRG. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review. BMC Med Inform Decis Mak 2010; 10:60. [PMID: 20950458 PMCID: PMC2970582 DOI: 10.1186/1472-6947-10-60] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 10/15/2010] [Indexed: 11/16/2022] Open
Abstract
Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor. Conclusions The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients.
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Affiliation(s)
- Víctor H Castillo
- Faculty of Mechanics and Electrical Engineering, University of Colima, México.
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Shield RR, Goldman RE, Anthony DA, Wang N, Doyle RJ, Borkan J. Gradual electronic health record implementation: new insights on physician and patient adaptation. Ann Fam Med 2010; 8:316-26. [PMID: 20644186 PMCID: PMC2906526 DOI: 10.1370/afm.1136] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients' responses. METHODS We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse's aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses. RESULTS Patient trust in the physician and security in the physician-patient relationship appeared to override most patients' concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the "third actor" in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room. CONCLUSIONS Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.
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Affiliation(s)
- Renée R Shield
- Department of Family Medicine, Warren Alpert Medical School of Brown University and Memorial Hospital of Rhode Island, Pawtucket, Rhode Island, USA.
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Dinakarpandian D, Williams AR, Dinakar C. Physician needs in health informatics: Just ask the docs. J Allergy Clin Immunol 2010; 125:1401-1403.e4. [DOI: 10.1016/j.jaci.2010.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 01/22/2010] [Accepted: 02/09/2010] [Indexed: 11/16/2022]
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Holden RJ. Physicians' beliefs about using EMR and CPOE: in pursuit of a contextualized understanding of health IT use behavior. Int J Med Inform 2010; 79:71-80. [PMID: 20071219 PMCID: PMC2821328 DOI: 10.1016/j.ijmedinf.2009.12.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 12/03/2009] [Accepted: 12/14/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE To identify and describe physicians' beliefs about use of electronic medical records (EMR) and computerized provider order entry (CPOE) for inpatient and outpatient care, to build an understanding of what factors shape information technology (IT) use behavior in the unique context of health care delivery. METHODS Semi-structured qualitative research interviews were carried out, following the beliefs elicitation approach. Twenty physicians from two large Midwest US hospitals participated. Physicians were asked questions to elicit beliefs and experiences pertaining to their use of EMR and CPOE. Questions were based on a broad set of behavior-shaping beliefs and the methods commonly used to elicit those beliefs. RESULTS Qualitative analysis revealed numerous themes related to the perceived emotional and instrumental outcomes of EMR and CPOE use; perceived external and personal normative pressure to use those systems; perceived volitional control over use behavior; perceived facilitators and barriers to system use; and perceptions about the systems and how they were implemented. EMR and CPOE were commonly believed to both improve and worsen the ease and quality of personal performance, productivity and efficiency, and patient outcomes. Physicians felt encouraged by employers and others to use the systems but also had personal role-related and moral concerns about doing so. Perceived facilitators and barriers were numerous and had their sources in all aspects of the work system. CONCLUSION Given the breadth and detail of elicited beliefs, numerous design and policy implications can be identified. Additionally, the findings are a first step toward developing a theory of health IT acceptance and use contextualized to the unique setting of health care.
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Affiliation(s)
- Richard J Holden
- School of Medicine and Public Health, University of Wisconsin-Madison, 750 Highland Avenue, Madison, WI 53705, USA.
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Peiris DP, Joshi R, Webster RJ, Groenestein P, Usherwood TP, Heeley E, Turnbull FM, Lipman A, Patel AA. An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation. J Med Internet Res 2009; 11:e51. [PMID: 20018588 PMCID: PMC2802562 DOI: 10.2196/jmir.1258] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 10/01/2009] [Accepted: 10/28/2009] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. OBJECTIVES Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily evaluate its acceptability to GPs as a point-of-care resource for both general and underserved populations. METHODS CVD risk estimation (based on Framingham algorithms) and risk-based management advice (using recommendations from six Australian guidelines) were programmed into a software package. Tool validation: Data from 137 patients attending a physician's clinic were analyzed to compare the tool's risk scores with those obtained from an independently programmed algorithm in a separate statistics package. The tool's management advice was compared with a physician's recommendations based on a manual review of the guidelines. Field test: The tool was then tested with 21 GPs from eight general practices and three Aboriginal Medical Services. Customized CDS-based recommendations were generated for 200 routinely attending patients (33% Aboriginal) using information extracted from the health record by a research assistant. GPs reviewed these recommendations during each consultation. Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted. RESULTS Validation testing: the tool's risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients. CONCLUSION A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention.
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Affiliation(s)
- David P Peiris
- The George Institute for International Health, University of Sydney, Sydney, Australia.
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50
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Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl J Med 2009; 360:1628-38. [PMID: 19321858 DOI: 10.1056/nejmsa0900592] [Citation(s) in RCA: 747] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals. METHODS We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption. RESULTS On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems. CONCLUSIONS The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.
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Affiliation(s)
- Ashish K Jha
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
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