Barriers to Electronic Health Record System Implementation and Information Systems Resources: A Structured Review

Gesulga, Jaillah Mae; Berjame, Almarie; Moquiala, Kristelle Sheen; Galido, Adrian

doi:10.1016/j.procs.2017.12.188

Cited by 77 publications

(95 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As a multientity network/system, EHR networks can increase the value of individual EHR investment by minimizing infrastructure redundancy, employing bargaining power, and drawing upon operational and technical efficiencies. 43 Second, hospital bed numbers were also found to be a predictor of certified EHR adoption, confirming prior findings. 39,40 Large hospitals were more likely to implement certified EHRs, which require significant investment in hardware and software.…”

Section: Discussionsupporting

confidence: 79%

<p>Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals</p>

Houser

et al. 2020

RMHP

View full text Add to dashboard Cite

Objective: The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods: Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ 2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results: Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52-3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22-2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34-2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion: The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.

show abstract

Section: Discussionsupporting

confidence: 79%

<p>Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals</p>

Houser

et al. 2020

RMHP

View full text Add to dashboard Cite

show abstract

“…Such systems have been implemented in many low, middle and high-income countries [3,4]. Many countries, particularly in high income settings, have also welcomed electronic health record keeping in the clinical environment [5], however this is not a viable option in various low-and-middle income contexts for several reasons, including complex infrastructure, network requirements and user resistance [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Consolidating strategic information to monitor progress against the UNAIDS 90-90-90 targets: evaluating the operational feasibility of an electronic HIV testing register in Cape Town, South Africa

Jacob

Rice

Kalk

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background HIV diagnosis in South Africa is based on a point-of-care testing (PoCT) algorithm with paper-based record-keeping. Aggregated testing data are reported routinely. To facilitate improved HIV case-based surveillance, the Western Cape Province implemented a unique pilot intervention to digitise PoCT results, at an individual level, and generate an electronic register using the newly developed Provincial Health Data Centre (PHDC). We describe the intervention (phased) and present an evaluation of the operational feasibility of the intervention. We also offer implementation insights into establishing electronic capture of individual level testing data. Methods Cross-sectional analyses were conducted on records of all patients attending a local Community Health Centre who had an HIV-PoCT during the study period. Data from the intervention were linked to the PHDC using a unique identifier and compared with aggregate data from the paper-based register. Correlation coefficients were calculated to quantify the correlation between the two monthly datasets. To support an understanding of the findings, the Department of Health project management team generated reflections on the implementation process, which were then grouped thematically into implementation lessons. Results In total, 11 337 PoCT records were digitised (70% (7954) during Phase I; and 30% (3383) during Phase II). Linkage of forms to the PHDC was 96% in Phase I and 98% in Phase II. Comparison with aggregate data showed high correlation during Phase I, but notable divergence during Phase II. Divergence in Phase II was due to stringent data quality requirements and high clinical staff turnover. Factors supporting implementation success in Phase I included direct oversight of data capturing by a manager with clinical and operational insight. Implementation challenges included operational, health system, and high cost-related issues. Conclusions We demonstrate that rapid digitisation of HIV PoCT data, without compromising currently collected aggregate data, is operationally feasible, and can contribute to person-level longitudinal HIV case-based surveillance. To take to scale, we will need to improve PoCT platforms and clerical and administrative systems. Although we highlight challenges, we demonstrate that electronic HIV testing registers can successfully replace manual registers and improve efforts to monitor and evaluate HIV testing strategies.

show abstract

“…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] . EHR implementation is difficult because it is not merely a technological change, but rather a sociotechnical change process that often results into changes in clinical workflows, the need to learn new (computer) skills or applications, introduction of extra tasks, and actual or perceived changes in the power structure and legal responsibilities within healthcare, such as threat to doctors' autonomy when computerized clinical decision support functionality is implemented [3][4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

“…Organizational readiness for change is a well-known factor in success or failure of organizational changes in general, and in EHR implementation in particular 3,[7][8][9][10][11][12][13] . Organizational readiness is defined as the extent to which organization staff are psychologically and behaviorally prepared 10 .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Organizational Readiness to Implement an Electronic Health Record System in a Low-Resource Settings Cancer Hospital: Structural Equation Modeling of Survey Data to Identify Relevant Factors

Kabukye

Keizer

Cornet

2019

Preprint

View full text Add to dashboard Cite

BackgroundOrganizational 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. ObjectiveTo identify and assess relevant variables that determine readiness to implement an EHR in oncology in a low-and-middle income setting. MethodsAt 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 Likertscale survey responses. ResultsOne 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 R2 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 clinical data, improved care coordination, reduction of errors, and time and cost saving. Recommended considerations for successful implementation include training, sensitization, organizational conflicts 3 and computer infrastructure. Conclusion Change management during EHR implementation in oncology in low-and-middle income setting should focus on attributes of the change and the change targets, including vision clarity, change appropriateness, change efficacy, presence of an effective champion, organizational flexibility, and collective self-efficacy. Particularly, issues of training, computer skills of staff, computer infrastructure, sensitization and strategic implementation need consideration.

show abstract

Barriers to Electronic Health Record System Implementation and Information Systems Resources: A Structured Review

Cited by 77 publications

References 37 publications

<p>Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals</p>

<p>Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals</p>

Consolidating strategic information to monitor progress against the UNAIDS 90-90-90 targets: evaluating the operational feasibility of an electronic HIV testing register in Cape Town, South Africa

Assessment of Organizational Readiness to Implement an Electronic Health Record System in a Low-Resource Settings Cancer Hospital: Structural Equation Modeling of Survey Data to Identify Relevant Factors

Contact Info

Product

Resources

About