A Sociotechnical Approach to Successful Electronic Health Record Implementation

Irizarry, Taya; Barton, Amy J.

doi:10.1097/nur.0b013e3182a872e3

Cited by 12 publications

(8 citation statements)

References 10 publications

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“…However, EHR implementation is a complex and challenging organizational change which is often resisted with planned or actual boycotts, and workarounds by medical staff to state-ofthe-art systems [3,4].Although failures are not commonly reported in literature [3], it is estimated that 50-75% of implementations of EHRs and other health information technologies fail-i.e. they overrun budgets or implementation time, do not provide end user satisfaction, or are completely abandoned [3][4][5][6][7].Implementation of EHRs is difficult because it is not merely a technological change, but rather a socio-technical change process that affect many aspects of the organization [8][9][10]. It often results into changes or disruptions in clinical workflows, introduction of extra tasks, or shifting of tasks from one cadre to another [3][4][5]11,12] e.g.…”

Section: Introductionmentioning

confidence: 99%

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

2020

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Background Organizational readiness for change is a key factor in success or failure of electronic health record (EHR) system implementations. Readiness is a multifaceted and multilevel abstract construct encompassing individual and organizational aspects, which makes it difficult to assess. Available tools for assessing readiness need to be tested in different contexts. Objective To identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. Methods At the Uganda Cancer Institute (UCI), a 100-bed tertiary oncology center in Uganda,we conducted a cross-sectional survey using the Paré model. This model has 39 indicator variables (Likert-scale items) for measuring 9 latent variables that contribute to readiness. We analyzed data using partial least squares structural equation modeling (PLS-SEM). In addition, we collected comments that we analyzed by qualitative content analysis and sentiment analysis as a way of triangulating the Likert-scale survey responses. Results One hundred and forty-six clinical and non-clinical staff completed the survey, and 116 responses were included in the model. The measurement model showed good indicator reliability, discriminant validity, and internal consistency. Path coefficients for 6 of the 9 latent variables (i.e. vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy) were statistically significant at p < 0.05. The R 2 for the outcome variable (organizational readiness) was 0.67. The sentiments were generally positive and correlated well with the survey scores (Pearson's r = 0.73). Perceived benefits of an EHR included improved quality, security and accessibility of

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Section: Introductionmentioning

confidence: 99%

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

2020

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“…Electronic health record (EHR) systems have increasingly replaced paper-based practices in hospitals, with the expectation of providing many clinical and organizational benefits [1,2]. Implementation of EHRs will inevitably change work practices in health care [3,4] and, if not properly managed, may result in many unexpected and unintended consequences. In addition to the benefits identified (eg, reduction of medication errors), health care professionals have reported disadvantages, such as increased emotional strain and increased errors when trying to learn and adapt to new technologies and managing their workflow disruptions [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study

Kaihlanen¹,

Gluschkoff²,

Hyppönen³

et al. 2020

JMIR Med Inform

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Background Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. Objective The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. Methods A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient’s care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. Results Poor EHR usability was associated with higher levels of stress related to information systems (β=.38; P<.001). The strength of the association did not depend on user age. Poor EHR usability was also associated with higher levels of cognitive failures (β=.28; P<.001). There was a significant interaction effect between age and EHR usability for cognitive failures (β=.04; P<.001). Young nurses who found the EHR difficult to use reported the most cognitive failures. Conclusions Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice.

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“…The study is underpinned by the socio-technical systems theory, which has been suggested as an appropriate framework with which to evaluate Health Information Technology (HIT) such as the EPR [ 33 – 35 ]. This paradigm states that ‘organisational and human (socio) factors and information technology system factors (technical) are inter-related parts of one system, each shaping the other’ [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study

Shiells

Diaz-Baquero

Štěpánková

et al. 2020

BMC Med Inform Decis Mak

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Background: The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective. Methods: An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added. Results: Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes. Conclusions: EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.

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A Sociotechnical Approach to Successful Electronic Health Record Implementation

Cited by 12 publications

References 10 publications

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

Assessment of organizational readiness to implement an electronic health record system in a low-resource settings cancer hospital: A cross-sectional survey

The Associations of Electronic Health Record Usability and User Age With Stress and Cognitive Failures Among Finnish Registered Nurses: Cross-Sectional Study

Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study

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