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

Abstract

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

Barriers and Facilitators of eHealth Adoption among Patients in Uganda – A Quantitative Study

“…Training has been identified as one of the key success factors in technology acceptance. Commensurate to our findings, receiving necessary training prior to using the system has been encouraged in several other studies [6], [38], [44], [19], [28], [21], [40], [30], [33]. Training equips users with the knowledge of the system [20], gives a chance to acclimate to the new processes and in the long run boosts confidence to use the system.…”

“…Lacking digital skills to operate a system can be aggravated by the little or no formal education. As reported in other studies [20], [24], [37], [40] the lack of ICT skills to operate digital technologies was a very big impediment to adoption. Whereas a study conducted in Finland indicated that digital literacy does not have a direct impact on adoption [58], research conducted in Uganda, found out that expectant mothers did not use digital health technologies in their routine antenatal care practices because they lacked technical skills to operate the internet, computers and smartphones [29].…”

“…Systems are as good as the users knowing their benefits, and training has been found to fulfill this. Reminding users of the usefulness of the systems increases the chances of adoption as alluded by several other studies [40], [30]. In some studies, communicating anticipated benefits was reported to increase user acceptance of the eHealth system [51], [5], [52].…”

“…A structured survey questionnaire formulated in English with three main themes (demographic data, barriers and facilitators) was used to collect data. Barriers and facilitators used in the questionnaire were drawn from existing studies [6], [19], [23], [28], [37]- [39], [21], [27], [29], [16], [22], [32], [30], [40], [41], [20], [33], [42], [10]. All authors designed the questionnaire, however it was specifically tailored to fit the scope of this study.…”

Organizational Readiness for the Implementation of a Three-Month Short-Course TB Preventive Therapy Regimen (3HP) in Four Health Care Facilities in Zimbabwe in 2020: A Mixed Methods Study

“…For example, an organization has to be willing and capable to implement a program for an effective outcome [6]. Studies indicate that about 50% of programs fail due to poor organisational readiness prior program implementation yet there is a dearth in the literature to indicate organizational readiness to implement the 3HP program among high burden, low-income TB settings such as Zimbabwe [7]. Such a gap in knowledge affects the optimum response to the TB preventive efforts of the country.…”