The impact of converting to an electronic health record on organizational culture and quality improvement

Nowinski, Cindy J.; Becker, Susan; Reynolds, Kate; Beaumont, Jennifer L.; Caprini, C.; Hahn, Elizabeth A.; Peres, Alan; Arnold, Ben

doi:10.1016/j.ijmedinf.2006.05.016

Cited by 38 publications

(43 citation statements)

References 15 publications

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“…Previous research has focused on understanding adoption rates of EHRs,1 2 how EHRs influence fundamental outcomes such as the cost and quality of healthcare delivery,3–7 and how they reshape organizational culture8 and clinical workflow9 10 in both intended and unintended ways 11. A growing literature providing in-depth, rich accounts of EHR use is generating valuable insights into how EHRs are being used by healthcare providers in healthcare delivery processes 12–14.…”

Section: Introductionmentioning

confidence: 99%

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

Lanham

Leykum

McDaniel³

2012

Journal of the American Medical Informatics Association

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ObjectiveDespite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns.DesignQualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice.MeasurementsAn existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices.ResultsWithin-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction.ConclusionWithin-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies.

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Section: Introductionmentioning

confidence: 99%

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

Lanham

Leykum

McDaniel³

2012

Journal of the American Medical Informatics Association

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“…Construct definitions and labels assigned to scales guided but did not dictate categorisation because labels were highly varied and often not a good indicator of instrument content ( e . g ., authors used the following construct labels for very similar measures of QI climate: organizational culture that supports QI [56], organizational commitment to QI [57], QI implementation [58], degree of CQI maturity [59], quality management orientation [60], and continuous improvement capability [61]). Instrument content was summarised in separate tables for each of the content domains from the InQuIRe framework: (1) CQI implementation and use, (2) organizational context, and (3) individual level factors.…”

Section: Methodsmentioning

confidence: 99%

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

et al. 2012

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BackgroundContinuous quality improvement (CQI) methods are widely used in healthcare; however, the effectiveness of the methods is variable, and evidence about the extent to which contextual and other factors modify effects is limited. Investigating the relationship between these factors and CQI outcomes poses challenges for those evaluating CQI, among the most complex of which relate to the measurement of modifying factors. We aimed to provide guidance to support the selection of measurement instruments by systematically collating, categorising, and reviewing quantitative self-report instruments.MethodsData sources: We searched MEDLINE, PsycINFO, and Health and Psychosocial Instruments, reference lists of systematic reviews, and citations and references of the main report of instruments. Study selection: The scope of the review was determined by a conceptual framework developed to capture factors relevant to evaluating CQI in primary care (the InQuIRe framework). Papers reporting development or use of an instrument measuring a construct encompassed by the framework were included. Data extracted included instrument purpose; theoretical basis, constructs measured and definitions; development methods and assessment of measurement properties. Analysis and synthesis: We used qualitative analysis of instrument content and our initial framework to develop a taxonomy for summarising and comparing instruments. Instrument content was categorised using the taxonomy, illustrating coverage of the InQuIRe framework. Methods of development and evidence of measurement properties were reviewed for instruments with potential for use in primary care.ResultsWe identified 186 potentially relevant instruments, 152 of which were analysed to develop the taxonomy. Eighty-four instruments measured constructs relevant to primary care, with content measuring CQI implementation and use (19 instruments), organizational context (51 instruments), and individual factors (21 instruments). Forty-one instruments were included for full review. Development methods were often pragmatic, rather than systematic and theory-based, and evidence supporting measurement properties was limited.ConclusionsMany instruments are available for evaluating CQI, but most require further use and testing to establish their measurement properties. Further development and use of these measures in evaluations should increase the contribution made by individual studies to our understanding of CQI and enhance our ability to synthesise evidence for informing policy and practice.

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“…In any case, HIT has the power to change care provision and hospital work in ways that are not always free from critical and unintended consequences (Ash et al 2007). In fact, despite the hype that usually surrounds the initiatives of HIT deployment, its promises for a safer, more efficient and effective healthcare have so far fallen short of expectations (Balka 2003;Berg 2001;Harrison et al 2007;Jones 2003;Nowinski et al 2007) and, as a consequence of this, it is reported that EPRs are being adopted in hospitals at a much lower rate than initially expected (Balfour et al 2009). …”

Section: Background and Motivationsmentioning

confidence: 99%

“Remain Faithful to the Earth!”*: Reporting Experiences of Artifact-Centered Design in Healthcare

Cabitza

2011

Comput Supported Coop Work

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In this paper we report about two design experiences in the domain of healthcare information technology that shed light on the advantages of getting rid of complex and abstract representations of hospital work and of concentrating on the artifacts that practitioners habitually use in their daily practice. We ground our approach in the recent literature on the often unintended shortcomings exhibited by healthcare information systems and propose a lightweight method to support the phases of requirement elicitation and functional design. We then discuss the main requirements expressed in our recent research activity and provide examples of how to address them in terms of modular and reusable design solutions.

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The impact of converting to an electronic health record on organizational culture and quality improvement

Cited by 38 publications

References 15 publications

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

Measuring organizational and individual factors thought to influence the success of quality improvement in primary care: a systematic review of instruments

“Remain Faithful to the Earth!”*: Reporting Experiences of Artifact-Centered Design in Healthcare

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