Users’ perspectives of key factors to implementing electronic health records in Canada: a Delphi study

Abstract

BackgroundInteroperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users’ perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature.MethodsA three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75%) or moderate (≥ 60-74%) according to user groups’ level of agreement on applicability and importance, partial (≥ 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance.ResultsThree Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (≥ 75% from questionnaire answers of user groups), for decision-making concerning EHR implementation. The10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and workload, resources availability, management, outcome expectancy, and interoperability.ConclusionsAmongst all factors influencing EHR implementation identified in a previous systematic review, ten were prioritized through this Delphi study. The varying levels of agreement between and within user groups could mean that users’ perspectives of each factor are complex and that each user group has unique professional priorities and roles in the EHR implementation process. As more EHR implementations in Canada are completed it will be possible to corroborate this preliminary result with a larger population of EHR users.

Dietitians’ Perspectives on Interventions to Enhance Adherence to Dietary Advice for Chronic Diseases in Adults

“…Whether the results of our study are transferable to other contexts such as the United States, Australia, and United Kingdom remains to be investigated. Second, the response rate (50% after 3 rounds) was relatively low, but similar to that in other studies [17,23]. Thirty-two dietitians completed the 3 rounds and, according to Okoli et al [20], 10-18 experts is an adequate sample size for a Delphi study.…”

“…However, a systematic review by Boulkedid et al [21] provided us with some guidance for improving our Delphi methodology and reporting data. In studies with a similar design [22][23][24], consensus on the importance and applicability of an intervention were defined as strong when at least 75% of dietitians reached agreement on both the importance and applicability of an intervention, moderate when 60%-74% of dietitians agreed on both the importance and applicability of an intervention, and partial when at least 60% of the dietitians reached consensus on only one aspect (importance or applicability) of an intervention. Absence of consensus was determined when less than 60% of dietitians agreed on either the importance or the applicability.…”

Knowledge Translation for Service Providers with Addiction or Recovery Experience: A Delphi Method

“…These advantages include the ability of researchers to (a) gather information about the topics for which there is lack of empirical data; (b) select experts-Delphi panelists-regardless of their geographical location; and (c) keep anonymity of participants and limit the possibility of certain participants to dominate the development of the consensus (de Meyrick, 2003;Gabb, Balen, Gibbs, Hall, & Teal, 2006;Thompson, 2009). The Delphi method, frequently used in health and social sciences (de Meyrick, 2003;Keeney et al, 2011;McBride, Pates, Ramadan, & McGowan, 2003;McGinn et al, 2012;Vazquez-Ramos, Leahy, & Hernandez, 2007), consists of a series of rounds, usually two or three, where questionnaires are built on the responses from the previous rounds. Participants are provided with the collective responses of the fellow Delphi panelists to learn about their opinion and, when applicable, to modify their own responses to reach a group consensus.…”

Recent Research Areas and Grand Challenges in Electronic Medical Record: A Literature Survey Approach

“…For instance, McGinn assessed factors affecting Canadian record EHR based on applicability and importance [15], and evaluated these factors during implementation and maintenance. The accuracy and availability of electronic patient record systems was evaluated by Lambdin [16].…”