Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep

Panyard, Daniel J.; Ramly, Edmond; Dean, Shannon M.; Bartels, Christie M.

doi:10.1016/j.ijmedinf.2017.11.014

Cited by 9 publications

(10 citation statements)

References 20 publications

(18 reference statements)

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“…Factors influencing nonadoption and abandonment are complex and include the health condition, technology, value proposition, adopter system (comprising professional staff, patient, and lay caregivers), organizations, wider context, and interaction and mutual adaptation among all these factors over time. For example, more specific mentioned reasons for nonuse are complexities related to regulation [15,16], dealing with changes in workflow [17], the trust of the population regarding the privacy and security of data, and the conflicting interest of different stakeholders in the health care system [18,19].…”

Section: Introductionmentioning

confidence: 99%

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop

Velthoven¹,

Cordón²

2019

J Med Internet Res

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Background There are various complex reasons that influence sustainable adoption of innovations in health care systems. Low adoption can be caused by a lack of support from one or more stakeholders because their needs and expectations are not always considered or aligned. Objective This study aimed to identify stakeholders’ perceptions of barriers and facilitators toward the sustainable adoption of digital health innovations. Methods A stakeholder workshop was attended by 12 participants with a range of backgrounds on August 25, 2017, including people representing the views from patients, carers, local hospitals, pharmacy retailers, health insurers, health services researchers, engineers, and technology and pharmaceutical companies in Switzerland. On the basis of adoption of innovation frameworks, we asked participants to interview each other about 3 factors influencing the adoption of digitally delivered health interventions: (1) Facilitators and barriers in the external system, (2) Needs and expectations of stakeholders, and (3) Safety, quality, and usability of innovations. The worksheets and videos generated from the workshop were qualitatively analyzed and summarized. Results Facilitators for adoption mentioned were high levels of income and education, and digital health is a high priority to stakeholders. Main common interests of different stakeholders were patient satisfaction and job protection. Health care spending was a misaligned interest: although some stakeholders were keen on spending more to obtain or provide the highest quality of care, others were focused on reducing health care spending to provide cost-effective services. Switzerland’s diversity and complexity, in terms of its organization with 26 cantons (administrative divisions), were barriers as these made it harder to ensure interoperability of interventions. A culture of innovation was considered a push factor, but adoption was inhibited by persistent paper-based systems, a fear of change, and unwillingness to share data. The sustainability of interventions can be promoted by making them patient-centered, meaning that patients should be involved throughout their development. Conclusions Promoting sustainable adoption of digital health remains challenging despite various push factors being in place. Barriers related to fragmentation, patient-centeredness, data security, privacy, trust, and job security need to be addressed. A strength is that people from a wide range of backgrounds attended the workshop. A limitation is that the findings are focused on the macro level. In-depth case studies of specific issues need to be conducted in different settings.

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Section: Introductionmentioning

confidence: 99%

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop

Velthoven¹,

Cordón²

2019

J Med Internet Res

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“…eReferral appears to reach three times as many primary care patients as quitline fax referral [ 7 – 9 ], with fairly equitable reach across patient subpopulations [ 8 , 9 ]. However, there are challenges to implementing eReferral [ 10 ]. Implementing EHR tools often requires extensive system-specific modifications [ 11 ] and engagement of multiple stakeholders [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, there are challenges to implementing eReferral [ 10 ]. Implementing EHR tools often requires extensive system-specific modifications [ 11 ] and engagement of multiple stakeholders [ 10 ]. Thus, eReferral often involves multiple rounds of modification and refinement, which can be expensive and time consuming.…”

Section: Introductionmentioning

confidence: 99%

“…Adaptations and refinements are often critical to effective implementation [ 12 ] and thereby to intervention reach, effectiveness, and population impact, as specified in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for intervention planning and evaluation [ 13 ]. The process of modifying implementation strategies to support intervention activities in clinical contexts is understudied [ 14 , 15 ], however, particularly for emerging EHR-guided intervention approaches like Ask-Advise-Connect eReferral [ 10 ]. Interventions incorporating EHR-supported implementation may involve adaptations to the basic clinical intervention, modifications to EHR functionalities, and modifications to training processes as well as other implementation strategies.…”

Section: Introductionmentioning

confidence: 99%

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Electronic health record closed-loop referral (“eReferral”) to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations

Zehner

Kirsch

Adsit

et al. 2022

Implement Sci Commun

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Background Health system change can increase the reach of evidence-based smoking cessation treatments. Proactive electronic health record (EHR)-enabled, closed-loop referral (“eReferral”) to state tobacco quitlines increases the rates at which patients who smoke accept cessation treatment. Implementing such system change poses many challenges, however, and adaptations to system contexts are often required, but are understudied. This retrospective case study identified adaptations to eReferral EHR tools and implementation strategies in two healthcare systems. Methods In a large clustered randomized controlled trial (C-RCT; NCT02735382) conducted in 2016–2017, 11 primary care clinics in two healthcare systems implemented quitline eReferral, starting with 1 pilot clinic per system followed by 2 phases of implementation (an experimental phase in 5–6 test clinics per system and then a system-wide dissemination phase in both systems). Adaptations were informed by stakeholder input from live trainings, follow-up calls and meetings in the first month after eReferral launch, emails, direct observation by researchers, and clinic staff survey responses. Retrospective, descriptive analysis characterized implementation strategy modifications and adaptations using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). A pre- and post-implementation survey assessed staff ratings of eReferral acceptability and implementation barriers and facilitators. Findings Major modifications to closed-loop eReferral implementation strategies included aligning the eReferral initiative with other high-priority health system objectives, modifying eReferral user interfaces and training in their use, modifying eReferral workflows and associated training, and maintaining and enhancing interoperability and clinician feedback functions. The two health systems both used Epic EHRs but used different approaches to interfacing with the quitline vendor and integrating eReferral into clinician workflows. Both health systems engaged in iterative refinement of the EHR alert prompting eReferral, the eReferral order, trainings, and workflows. Staff survey comments suggested moderate acceptability of eReferral processes and identified possible targets for future modifications in eReferral, including reducing clinician burden related to EHR documentation and addressing clinicians’ negative beliefs about patient receptivity to cessation treatment. Conclusions System-wide implementation of tobacco quitline eReferral in primary care outpatient clinics is feasible but requires extensive coordination across stakeholders, tailoring to local health system EHR configurations, and sensitivity to system- and clinic-specific workflows. Trial registration www.clinicaltrials.gov, NCT02735382. Registered on 12 August 2016.

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“…Factors influencing non-adoption and abandonment are complex and include: the health condition, technology, value proposition, adopter system (comprising professional staff, patient, and lay caregivers), organization(s), wider context, and interaction and mutual adaptation between all these factors over time [4,8]. Some commonly mentioned reasons for non-use are: 1) complexities related to regulation [9,10]; dealing with changes in workflow [11]; and 3) the conflicting interest of different stakeholders in the healthcare ecosystem [12,13].…”

Section: Introductionmentioning

confidence: 99%

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop (Preprint)

Velthoven¹,

Cordón²

2018

Preprint

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Background: There are various complex reasons that influence sustainable adoption of innovations in healthcare systems. Low adoption can be caused by a lack of support from one or more stakeholders and their needs and expectations are not always considered or aligned. Objective: To identify stakeholders' perceptions on barriers and facilitators towards the sustainable adoption of digital health innovations. Methods: A stakeholder workshop was attended by twelve participants with a range of backgrounds on 25

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Bridging clinical researcher perceptions and health IT realities: A case study of stakeholder creep

Cited by 9 publications

References 20 publications

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop

Electronic health record closed-loop referral (“eReferral”) to a state tobacco quitline: a retrospective case study of primary care implementation challenges and adaptations

Sustainable Adoption of Digital Health Innovations: Perspectives From a Stakeholder Workshop (Preprint)

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