Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland

Abstract

Aims and objectives To explore the impact of implementing an electronic health record system on staff at a Scottish hospice. Background Electronic health records are broadly considered preferable to paper‐based systems. However, changing from one system to the other is difficult. This study analysed the impact of this change in a Scottish hospice. Design Naturalistic prospective repeated‐measures mixed‐methods approach. Methods Data on the usability of the system, staff engagement and staff experience were obtained at four time points spanning 30 months from inception. Quantitative data were obtained from surveys, and qualitative from concurrent analysis of free‐text comments and focus group. Participants were all 150 employees of a single hospice in Scotland. Results Both system usability and staff engagement scores decreased for the first two years before recovering at 30 months. Staff experience data pointed to two main challenges: (1) Technical issues, with subthemes of accessibility and usability. (2) Cultural issues, with subthemes of time, teamwork, care provision and perception of change. Conclusions It took 30 months for system usability and staff engagement scores to rise, after falling significantly for the first two years. The unintended outcomes of implementation included challenges to the way the patient story was both recorded and communicated. Nevertheless, this process of change was found to be consistent with the ‘J‐curve’ theory of organisational change, and as such, it is both predictable and manageable for other organisations. Relevance to clinical practice It is known that implementing an electronic health record system is complex. This paper puts parameters on this complexity by defining both the nature of the complexity (‘J’ curve) and the time taken for the organisation to begin recovery from the challenges (two years). Understanding these parameters will help health organisations across the world plan more strategically.

A screening tool for predicting gatekeeping behaviour

“…Team dynamics play a substantial role in the success of any initiative (Snowden & Kolb, ). Initially the research team had hoped that if one or two members of the nursing team reported positive experiences of recruitment then it might encourage others to engage.…”

“…The method has successfully been used in previous studies designed to better understand satisfaction in childbirth (Hollins‐Martin, Snowden, & Martin, ; Snowden et al., ), the process of becoming competent as a nurse prescriber (Snowden, ; Snowden & Martin, ,b) and the process of organizational change associated with implementing an electronic health record (Snowden & Kolb, ). It is a pragmatic method of synthesizing primary data with literature to produce more generalizable results than doing either alone (Snowden & Martin, ,b).…”

Improving quality and use of routine health information system data in low- and middle-income countries: A scoping review

“…Data quality and data use interventions in high-income countries heavily relied on the use of technology. Examples are the use of electronic medical or health record systems to improve data quality [57][58][59][60][61] and approaches to enhance the interoperability of such data sources to enhance the availability of data and use [58,60,62,63]. At the same time, these interventions were target-specific compared to the interventions in low-and middle-income countries, where targets were broader.…”

DIFUSÃO DA INOVAÇÃO TECNOLÓGICA e-SUS AB: ACEITAÇÃO OU REJEIÇÃO?

“…(8) Em estudos nacionais e internacionais a incompatibilidade de sistemas de informação em relação ao processo de trabalho em saúde, bem como a sua complexidade de uso foram fatores que contribuíram para o seu insucesso e com repercussões negativas sobre a gestão e assistência. (1)(2)5,(10)(11) O desenvolvimento de tecnologias da informação deve ser adequado às necessidades informacionais de seus potenciais usuários, além de contribuir para a gestão das informações que emergem do processo de trabalho. (12)(13) Para ser amplamente adotada como uma tecnologia inovadora,deve instrumentalizar as pessoas com vistas a qualificar o fluxo de informações, o planejamento e a tomada de decisões assertiva, pois do contrário tende a ser rejeitada.…”

“…(2,(12)(13)(14) Além disso, a gestão do cuidado também tem sido prejudicada quando da utilização inadequada de sistemas de informação, acarretando impactos negativos sobre a segurança do paciente, famílias e comunidades. (11,15) A subutilização não pode ser repetida com os sistemas de software da estratégia e-SUS AB, pois a sua principal premissa é proporcionar a gestão da informação voltada para o planejamento e a tomada de decisões locais. (3,5) Espera-se que a utilização dos sistemas de software da estratégia e-SUS AB favoreçam a sistematização de dados, desde a coleta até a análise das informações, instrumentalizando a organização do trabalho e a gestão do cuidado.…”