Comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records: a systematic review

Abstract

BackgroundElectronic 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.MethodsCovering 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.ResultsOf 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.ConclusionsThis 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.

Investigating the Organizational and the Environmental Issues that Influence the Adoption of Healthcare Information Systems in Public Hospitals of Iraq

“…Several studies concluded that time-insufficiency and heavy workload in healthcare sector were considered important factors negatively affecting the adoption of HIS (Boonstra & Broekhuis, 2010;McGinn et al, 2011). On the other hand, other researchers did not find a significant effect of workload as a job stressor (Calisir, Gumussoy, & Iskin, 2011;Dagnone et al, 2006).…”

“…As hypothesized, WOL was found to have a significant negative effect on the use of HIS inside the hospital and its effect was the largest among the environmental factors in this study. Other studies also concluded that heavy workload can cause staff to develop negative attitudes towards the adoption of new technologies (Boonstra & Broekhuis, 2010;Kale & Goh, 2014;McGinn et al, 2011). Vendor support and post-deployment services was also found to be a significant contributor to foster the adoption of HIS systems as those systems are normally complex systems and involve a high degree of technicality that requires the presence of the vendors or the developers after the system installation to train the staff at the starting stage and help them to overcome any possible problems.…”

“…Also, the examination of the factors that drive technology adoption within hospitals is still relatively lagging compared to other industries (Escobar-Rodríguez & Romero-Alonso, 2013;Schnall & Bakken, 2011). Another point that needs to be considered is that the majority of empirical studies addressing the issue of HIS adoption were conducted in western and developed countries (Escobar-Rodríguez & Romero-Alonso, 2013;McGinn et al, 2011;Venkatesh et al, 2011), which encouraged the current study to investigate this issue within the new environment of Iraq as each context and each society has its own specificity and its own circumstances that differs from other contexts (Castillo, Martínez-García, & Pulido, 2010;Holden & Karsh, 2010;Novak et al, 2012;Venkatesh et al, 2011;Venkatesh & Zhang, 2010), and it would be misleading to conclude that there is one suitable solution for all scenarios (Boonstra & Broekhuis, 2010). The previous reasons in addition to the troubled situation of HIS in Iraqi public hospitals (Al Hilfi et al, 2013;Ali, Abdulsalam, & Hasan, 2011) have stimulated this study to empirically investigate this important issue by examining the important factors that influence the healthcare staff's attitude in Iraqi public hospitals.…”

“…The mere availability of HIS systems within the hospital will not guaranty that the staff will use it and commit to it (Avgar et al, 2012). That's why the staff's attitude must not be underestimated as a contributor to the adoption of HIS and should be accounted for, as this adoption of technology is a precondition for its success as asserted by many researchers (Cresswell & Sheikh, 2013;McGinn et al, 2011;Ward, Stevens, Brentnall, & Briddon, 2008). Also, the examination of the factors that drive technology adoption within hospitals is still relatively lagging compared to other industries (Escobar-Rodríguez & Romero-Alonso, 2013;Schnall & Bakken, 2011).…”

“…The implementation of those innovations into modern hospitals has become inevitable as many countries are trying to digitize their healthcare institutions (Chang, Hwang, Yen, & Lian, 2006). Simultaneously, these HIS systems introduce new work experiences to healthcare staff that did not exist previously, which can create challenges that need to be tackled properly in order to assure the adoption of such systems by healthcare staff and consequently to achieve its success (Cresswell & Sheikh, 2013;McGinn et al,result, this low adoption of HIS systems implies the loss of those substantial budgets that probably cannot be reallocated again for the same purpose. Another reason for HIS low adoption is the complexity of those technologies (Avgar, Litwin, & Pronovost, 2012;Cresswell & Sheikh, 2013;Lluch, 2011;Thakur, Hsu, & Fontenot, 2012;Venkatesh, Sykes, & Zhang, 2011), which might discourage the healthcare staff to use it as it will require them to attend training programs and adds time burdens to the staff's already loaded schedule (Boonstra & Broekhuis, 2010;McGinn et al, 2011).…”