A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers

Dennehy, Patricia; White, Mary; Hamilton, Andrew; Pohl, Joanne M.; Tanner, Clare; Onifade, Tiffiani J.M.; Zheng, Kai

doi:10.1136/amiajnl-2011-000117

Cited by 21 publications

(30 citation statements)

References 27 publications

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“…; Dennehy et al. ; Gibbons ). If the adoption of EHRs is slower in underserved areas, there is a risk of creating a “digital divide” in access to benefits from health information technology (Blumenthal et al.…”

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confidence: 99%

“…These disparities may be caused by many interrelated mechanisms (Smedley, Stith, and Nelson 2003), including limited or delayed access to new health technology ). Ambulatory providers who serve these populations may face disproportionate barriers to EHR adoption, including resource constraints, organizational complexity, a less favorable business case for adoption, and lack of expertise necessary to implement and integrate EHRs into practice workflow (Miller and West 2007;Miller et al 2009;Dennehy et al 2011;Gibbons 2011). If the adoption of EHRs is slower in underserved areas, there is a risk of creating a "digital divide" in access to benefits from health information technology (Blumenthal et al 2006).…”

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confidence: 99%

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Geographic Variation in Ambulatory Electronic Health Record Adoption: Implications for Underserved Communities

King

Furukawa

Buntin

2013

Health Services Research

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Objective. To describe small area variation in ambulatory electronic health record (EHR) adoption and assess evidence of a "digital divide" in whether adoption is lagging in traditionally underserved communities. Data Sources. Survey data on U.S. ambulatory health care sites (261,973 sites representing 716,160 providers) collected by SK&A Information Services in 2011. Study Design. We examined cross-sectional variation in two measures of local area EHR adoption: share of providers at sites using an EHR with e-prescribing functionality; and predicted probability of EHR adoption for the average site. Local areas were defined as Public Use Microdata Areas (n = 2,068). Using multivariate regression, we examined the association between adoption and three area characteristics: high concentration of minority population; high concentration of low-income population; and metropolitan status. Principal Findings. EHR adoption varied significantly across local areas, ranging from 8 to 88 percent with a median of 41 percent. Adoption was lower in large metropolitan areas; areas with high concentration of minority population in the Northeast and West; and areas with high concentration of low-income population in the Midwest. Conclusions. Our 2011 estimates suggest there was substantial room for increased EHR adoption across the United States, including some underserved areas with relatively low EHR adoption rates. Further research should monitor policy initiatives in these areas and examine sources of heterogeneity in low-and high-adoption communities.

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Geographic Variation in Ambulatory Electronic Health Record Adoption: Implications for Underserved Communities

King

Furukawa

Buntin

2013

Health Services Research

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“…[19] Trudel, Marie-Claude, Pare, Guy, Laflamme, Jonathan, Health information technology success and the art of being mindful: Preliminary insights from a comparative case study analysis, Health Care Management Review, 2012, 37 (1), [31][32][33][34][35][36][37][38][39][40][41][42] …”

Section: Resultsmentioning

confidence: 99%

“…The empirical studies (27 papers from [6] to [32]) were all case studies and action research-type studies using qualitative research methodologies (e.g. interviews, observation and documentation analysis).…”

Section: Research Trendsmentioning

confidence: 99%

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A Review of Health Information Technology Implementation Success Factors: Importance of Regulation and Finance

Nguyen¹,

Saranto²,

Tapanainen³

et al. 2014

2014 47th Hawaii International Conference on System Sciences

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Finding the factors contributing to the successful implementation of Health Information Technology (HIT) can help relieve the stress on healthcare systems worldwide caused by e.g. aging populations. This research reviewed the existing literature and identified 16 success factors for HIT implementation, of which one, the influence of external environment, was not found by prior reviews. This factor is crucial in HIT implementation because healthcare organizations in many countries are highly regulated by government policy and dependent on subsidies. The existing research showed a clear tendency for qualitative empirical work in HIT implementation, and in particular, on individual case studies, creating the need for future quantitative research on HIT implementation success factors. The review also suggested a pyramidal research approach and a taxonomy which shows the interactions of different stakeholders with implementers. These can serve as a reference for scholars and implementers of HIT in studying HIT implementation success factors.

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Medication safety after implementation of a commercial electronic health record system in five safety-net practices: A mixed methods approach

Pohl

Tanner

Hamilton³

et al. 2014

Journal of the American Association of Nurse Practitioners

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Purpose This study, conducted in five safety‐net practices, including two nurse‐managed health centers (NMHCs) and three federally qualified health centers (FQHCs), examined the impact of implementing a commercial electronic health records (EHRs) system on medication safety. Data source A mixed methods approach with two sources of data were used: (a) a query of prescription records captured by the EHR retrieving co‐prescribed medications with identified drug–drug interaction (DDI) risks, and (b) semistructured interviews with clinicians and leadership about the usability and benefits of EHR‐embedded clinical decision support in the form of DDI alerts. Conclusions We found an exceptionally low rate of DDI pairs in all five practices. Only 130 “true” DDI pairs were confirmed representing 149,087 visits and 62 providers. Among the 130, the largest categories were related to antihypertensive medications, which are in fact often prescribed together. There were no significant differences between physicians and nurse practitioners on the rate of DDI pairs nor between NMHCs and FQHCs. Implications for practice Implementation of an EHR in these five safety‐net settings had a positive impact on medication safety. The issue of missing end dates is noteworthy in terms of DDIs and unnecessary alerts that could lead to alert fatigue.

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A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers

Cited by 21 publications

References 27 publications

Geographic Variation in Ambulatory Electronic Health Record Adoption: Implications for Underserved Communities

Geographic Variation in Ambulatory Electronic Health Record Adoption: Implications for Underserved Communities

A Review of Health Information Technology Implementation Success Factors: Importance of Regulation and Finance

Medication safety after implementation of a commercial electronic health record system in five safety-net practices: A mixed methods approach

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