VA QUERI Informatics Paper: Information Technology for Clinical Guideline Implementation: Perceptions of Multidisciplinary Stakeholders

Lyons, Stacie Salsbury; Tripp–Reimer, Toni; Sorofman, Bernard A.; DeWitt, Jane E.; BootsMiller, Bonnie J.; Vaughn, Thomas; Doebbeling, Bradley N.

doi:10.1197/jamia.m1495

Cited by 56 publications

(46 citation statements)

References 23 publications

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“…Therefore, any IT implementation plans should address concerns of the stakeholders in order to build a better system. 35 …”

Section: Issues In It Implementationmentioning

confidence: 99%

“…35,36 As IT becomes more integrated into the care delivery system, IT implementation is likely to expand to include other participants in the health care setting. The IT system needs to interface with, and be responsive to, patients, managers, providers, researchers, and the public.…”

Section: Issues In It Implementationmentioning

confidence: 99%

“…2 Providers, other clinicians, and managers share many concerns regarding the use of IT in implementing EBPs. 33,35 An example of an important clinician issue is that outpatient laboratory test results are often not reviewed and acted upon within reasonable time frames. 37 Clinicians desire a system that allows them to review and act upon test results safely and efficiently.…”

Section: Clinician/provider Issuesmentioning

confidence: 99%

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Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

2006

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The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them. T he U.S. health care system is a $1.6-trillion industry that is undergoing rapid changes, facing increasing market pressure and competition for scarce resources. 1 The industry involves multiple private and public stakeholders, including provider associations, health care delivery organizations, insurers, consumers, community networks, and local, state, and federal agencies. It is an information intensive industry, 2 and yet it has lagged behind other industries in its investments and use of communication and information technology (IT). [3][4][5] The acquisition and implementation of IT have great implications for the operations of health care organizations because of: (1) rapidly rising health care costs; (2) escalating concerns surrounding issues of patient safety and medical errors; (3) call for improving the provision of evidence-based care; and (4) increasing regulatory requirements. 2,6 In particular, the Institute of Medicine (IOM) and the National Academy of Engineering have identified IT as crucial for building an improved health care delivery system that achieves the 6 health system 21st century attributes of being safe, effective, patientcentered, timely, efficient, and equitable. 3 Industry groups outside of health care, such as the Leapfrog Group, as well as the U.S. government, have encouraged IT investments as a solution to reduce medication errors and patient safety problems. 7-9 IT use has been shown to yield significant improvements in quality, cost containment, and patient safety in several empirical studies. [10][11][12] However, relatively little research has focused on identifying effective approaches for IT implementation and applications in evidence-based practices (EBPs). Evidence-based practice is the process of using current best evidence from well-designed research conscientiously and judiciously, in conjunction with patient values and clinical expertise, to guide health care dec...

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“…Therefore, any IT implementation plans should address concerns of the stakeholders in order to build a better system. 35 …”

Section: Issues In It Implementationmentioning

confidence: 99%

Section: Issues In It Implementationmentioning

confidence: 99%

Section: Clinician/provider Issuesmentioning

confidence: 99%

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Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

2006

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“…As a result, even when e-prescribing implementation is financially underwritten the perceived and real non-financial costs can cause failure. [2][3][4]6 However, the reporting of programs in Massachusetts 4 and New Jersey 3 that are piloting the apportionment of system-wide benefits to practices in the forms of implementation assistance are an encouraging connection of system-wide benefits to component parts (practices). Time is another important system consideration in HIT implementation.…”

mentioning

confidence: 99%

“…Similarly, in a large multisite focus group study of 18 medical centers, Lyons and colleagues demonstrated that different stakeholder groups hold different perceptions of the barriers and facilitators to using HIT to implement evidence-based practice. 6 Thus, an information system needs to be adapted during design, implementation, and ongoing maintenance to address the unique characteristics of the local context and continually assess and meet the needs of its providers, patients, and managers. Leu and colleagues created a series of process diagrams describing the clinical context in which HIT systems are used.…”

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confidence: 99%

The Role of Systems Factors in Implementing Health Information Technology

Doebbeling

Pekny

2008

J GEN INTERN MED

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T his issue of the Journal of General Internal Medicine (JGIM) includes a variety of important articles on the different dimensions of the role of health information technology (HIT) in medical practice. Several of the articles provide key insights into issues which are important in the effective implementation of HIT to change practice. We have noted several key themes across this issue, which provide insights into future clinical and research directions needed to ensure the successful implementation of HIT to change practice. We start by taking a "system" perspective and then note some of the detailed factors affecting HIT implementation.An underlying theme of these articles is that HIT must be an integral part of the health care system and that being aware of the "system", its properties, its time-varying characteristics, its complexity, and the surroundings in which the system exists strongly influences the success of HIT. For example, Leu et al. 1 makes the key point that "Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described". That is, the probability of a successful HIT implementation is greatly increased by a well-characterized, deliberately designed host set of health care processes. Furthermore, expectations of HIT within a health care process must be realistic with respect to benefits and costs. White 2 makes several fundamental observations about the health care system and HIT. He notes that "so much medical care involves acquiring, sorting, categorizing, exchanging, imparting and using information for treatment decisions actions…". Although health care has many dimensions beyond information processing, the key role of information to health care provides an inescapable first-principles argument about the enormous potential system benefits of HIT. However, many of the articles in this issue address the fact that apportioning these potential benefits and how they are experienced over time are significant system factors affecting HIT implementation. [3][4][5] Consider the articles discussing electronic prescribing. 3,4 The aggregate system benefits are well established in terms of, for example, reducing adverse drug events, but the costs of the implementation are borne by those who implement and use e-prescribing. These costs are both financial and otherwise. As a result, even when e-prescribing implementation is financially underwritten the perceived and real non-financial costs can cause failure.

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Smart Home Technology for the Elderly: Perceptions of Multidisciplinary Stakeholders

Sponselee

Schouten

Bouwhuis

et al.

Communications in Computer and Information Science

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The "implementation" and use of smart home technology to lengthen independent living of non-instutionalized elderly have not always been flawless. The purpose of this study is to show that problems with smart home technology can be partially ascribed to differences in perception of the stakeholders involved. The perceptual worlds of caregivers, care receivers, and designers vary due to differences in background and experiences. To decrease the perceptual differences between the stakeholders, we propose an analysis of the expected and experienced effects of smart home technology for each group. For designers the effects will involve effective goals, caregivers are mainly interested in effects on workload and quality of care, while care receivers are influenced by usability effects. Making each stakeholder aware of the experienced and expected effects of the other stakeholders may broaden their perspectives and may lead to more successful implementations of smart home technology, and technology in general.

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VA QUERI Informatics Paper: Information Technology for Clinical Guideline Implementation: Perceptions of Multidisciplinary Stakeholders

Cited by 56 publications

References 23 publications

Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

The Role of Systems Factors in Implementing Health Information Technology

Smart Home Technology for the Elderly: Perceptions of Multidisciplinary Stakeholders

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