Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery

Carpiano, Richard M.; Flocke, Susan A.; Frank, Scott; Stange, Kurt C.

doi:10.1016/s0091-7435(02)00024-5

Cited by 45 publications

(34 citation statements)

References 17 publications

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Section: Discussionsupporting

confidence: 80%

“…It is important to note, however, that these problems are not unique to this practice. We saw similar communication and decision-making issues in other practices participating in this program, and previous research 17,23 has found that communication patterns and other system features affect practice improvement efforts.Because we report a case study of a single primary care practice in the northeastern United States, we cannot capture the full impact that EMR implementation may have on primary care practices. This study does show that, at a minimum, communication, decision making and confl ict within practices are important issues determining the results of EMR implementation.…”

supporting

confidence: 80%

See 1 more Smart Citation

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

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PURPOSE Electronic medical record (EMR) systems offer substantial opportunities to organize and manage clinical data in ways that can potentially improve preventive health care, the management of chronic illness, and the fi nancial health of primary care practices. The functionality of EMRs as implemented, however, can vary substantially from that envisaged by their designers and even from those who purchase the programs. The purpose of this study was to explore how unique aspects of a family medicine offi ce culture affect the initial implementation of an EMR. METHODSAs part of a larger study, we conducted a qualitative case study of a private family medicine practice that had recently purchased and implemented an EMR. We collected data using participant observation, in-depth interviews, and key informant interviews. After the initial data collection, we shared our observations with practice members and returned 1 year later to collect additional data.RESULTS Dysfunctional communication patterns, the distribution of formal and informal decision-making power, and internal confl icts limited the effective implementation and use of the EMR. The implementation and use of the EMR made tracking and monitoring of preventive health and chronic illness unwieldy and offered little or no improvement when compared with paper charts.CONCLUSIONS Implementing an EMR without an understanding of the systemic effects and communication and the decision-making processes within an offi ce practice and without methods for bringing to the surface and addressing confl icts limits the opportunities for improved care offered by EMRs. Understanding how these common issues manifest within unique practice settings can enhance the effective implementation and use of EMRs. INTRODUCTIONB oth the Institute of Medicine and the Future of Family Medicine project have recommended the use of information technologies and electronic medical record (EMR) systems as tools for improving the quality of care 1 and patient safety. 2,3 Recent research has shown that information technologies can reduce medication errors, 4 improve adherence to clinical practice guidelines, 5 and improve the delivery of preventive health services, 6 thereby potentially improving health outcomes for patients. 7 In addition, using an EMR that includes electronic prescribing as well as electronic charting offers substantial fi nancial benefi ts to primary care organizations and the health system as a whole. 8 Even so, relatively few primary care practices use EMRs. 9 Reasons for not adopting EMRs may include the temporary loss of revenue associated with EMR implementation, 8 physician perception that EMRs negatively affect workfl ow, and concerns about patient privacy. 9 Even in settings where clinicians are committed to EMRs, implementation requires skilled users and a commitment to making the EMR an integral part of the 10 Without these personal and institutional commitments to full implementation, EMRs may actually represent a net fi nancial drain on primary care pr...

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Section: Discussionsupporting

confidence: 80%

supporting

confidence: 80%

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Crosson¹,

Stroebel²,

Scott

et al. 2005

The Annals of Family Medicine

View full text Add to dashboard Cite

show abstract

“…This implies that one element of Ajzen's Theory of Planned Behavior, the strength of a physician's belief that he or she can control factors that facilitate or impede, in this case, CRC screening, 25 may promote screening. This matches the findings of Carpiano et al 39 of an association between physician tenacity and increased delivery of preventive services. In fact, several of the barriers to and facilitators of CRC screening mentioned by high (and sometimes low) screeners have been associated with use of cancer screening tests.…”

Section: Discussionsupporting

confidence: 91%

Physician-Patient Colorectal Cancer Screening Discussions by Physicians' Screening Rates

O'Farrell¹,

Green²,

Reid³

et al. 2012

The Journal of the American Board of Family Medicine

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Background: Most physicians report routinely recommending colorectal cancer (CRC) screening, but many eligible patients are not screened. To better understand this finding, we explored the relationship between the content of hypothetical patient-physician CRC screening discussions and CRC screening rates in physicians' practices.Methods: Semistructured interviews, including role-playing, with 24 primary care physicians explored their CRC screening approach with average-risk patients. Qualitative analysis examined physician-reported components of the CRC screening discussion, then compared findings between physicians with high (>60%, n ‫؍‬ 16) and low (<45%, n ‫؍‬ 8) CRC screening rates (based on HEDIS criteria). We conducted no statistical tests because of the small sample size and its exploratory aims.Results: High screeners used dramatic language (eg, patient stories) and mentioned risk of death, disability, or surgery from CRC in screening discussion role-plays more often than low screeners. High screeners frequently offered fecal occult blood testing, flexible sigmoidoscopy, and colonoscopy as equally acceptable screening options. High screeners more commonly described solutions for overcoming CRC screening barriers.Conclusions: Encouraging providers to use risk-specific messaging about the consequences of CRC, offering screening option choices, and promoting a problem-solving approach to surmount barriers are potential strategies for increasing CRC screening rates. (J Am Board Fam Med 2012;25:771-781.)

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“…32,33 RNs have more clinical training, and Watkins 34 lists tenacity as a central component to the process of nurse's training. Carney et al 35 and Carpiano et al 36 have identified "tenacity," the acceptance of and adherence to guidelines, as an important component in teams for implementing clinical processes into practices. If tenacity is an important component for teams to successfully implement new clinical processes, whether it is something inherent or something acquired by those who continue their careers as RNs, it warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Does the "Office Nurse" Level of Training Matter in the Family Medicine Office?

Erickson

Targonski

et al. 2012

The Journal of the American Board of Family Medicine

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Tools, teamwork, and tenacity: an examination of family practice office system influences on preventive service delivery

Cited by 45 publications

References 17 publications

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Implementing an Electronic Medical Record in a Family Medicine Practice: Communication, Decision Making, and Conflict

Physician-Patient Colorectal Cancer Screening Discussions by Physicians' Screening Rates

Does the "Office Nurse" Level of Training Matter in the Family Medicine Office?

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