Factors Influencing Implementation and Outcomes of a Dental Electronic Patient Record System

Abstract

Implementation of clinical information systems is often dificult and costly. Little is known about how to implement electronic patient records in a complex dental school environment. The purpose of this study is to report how such a system was implemented at the University of Texas Health Science Center at Houston Dental Branch and to provide insights that may be useful for other institutions. To identify success factors and barriers, we reviewed project documents, interviewed key individuals on the implementation team, and surveyed end users before and after implementation. Eight critical issues were identiied after extensive interviews with the project team. Surveys of students, faculty, and staff before and after implementation indicated that users had mixed feelings about the system in terms of eficiency and time required compared with paper charts. After using the system, many users felt that the electronic patient record improved patient care and that they would recommend such a system to dentists starting a new practice. By sharing lessons learned and knowledge about the science of implementation, we hope to reduce failures and costs for dental schools embarking on large-scale information technology implementations.

Positive Impacts of Electronic hand‐off systems designs on Nurses’ communication effectiveness

“…Using information systems to present various kinds of data on a single screen allows for a smoother workflow, and providing on‐screen guidance can aid in decision‐making, both of which are highly positive enhancements that a system can bring (Johnson & Wiles, ). In other words, using multiple or nested windows may prevent the staff from quickly understanding the patient’s current conditions, and omitting important information from the decision‐making process, which can introduce errors (Walji et al, ). Therefore, the design of an electronic hand‐off system based on ISBAR design or not is used to distinguish the experimental and control groups in this study.…”

The Chief Clinical Informatics Officer (CCIO)

“…In many dental practices, the dentist/owner leads the EHR implementation assisted by IT consultants or dental EHR vendors. Little consideration for the impact on workflow or decision-making during patient care have resulted in poor usability of dental EHRs, increased work load, and reduced time with patients [71][72][73]. The National Institute of Dental and Craniofacial Research established the first dental practice-based research networks (DPBRN) in 2005 to support big data analyses from dental EHRs to increase efficiency, lower research cost, and permit longitudinal studies not feasible with traditional methods [74].…”

Implementing a Large-scale Electronic Health Record System in the Primary Healthcare Centres in Saudi Arabia

“…as that associated with the purchase of a new system (Slight et al, 2014;Walji et al, 2009); and ongoing costs, such as maintenance, training, developing infrastructure and provision of technical support Ludwick & Doucette, 2009a).…”

“…However, usability issues are not detectable prior to the actual implementation of the EHRS (Khajouei et al, 2011). Thus, the project team should consider an early pilot implementation phase to detect any issues that may lead to implementation failure (Fullerton et al, 2006;Walji et al, 2009).…”

“…Likewise, internationally, the cost of EHRS implementation is classified as a barrier to the success of the projects (e.g. Gagnon, Nsangou, et al, 2014;Jha, Bates, et al, 2009;Jotkowitz et al, 2006;Koivunen et al, 2008;Kruse, Kristof, et al, 2016;Leon et al, 2007;Ludwick & Doucette, 2009b;McAlearney et al, 2005;Nakamura et al, 2010;Walji et al, 2009). It is worth noting that my study is the only one which has examined the impact of the FR to on the implementation of large-scale EHRS in the Saudi PHCs.…”