Assessing organizational capacity for achieving meaningful use of electronic health records

Abstract

Background Health care institutions are scrambling to manage the complex organizational change required for achieving meaningful use (MU) of electronic health records (EHR). Assessing baseline organizational capacity for the change can be a useful step toward effective planning and resource allocation. Purpose This article describes an adaptable method and tool for assessing organizational capacity for achieving MU of EHR. Data on organizational capacity (people, processes, and technology resources) and barriers are presented from outpatient clinics within one integrated health care delivery system; thus, the focus is on MU requirements for eligible professionals, not eligible hospitals. Methods We conducted 109 interviews with representatives from 46 outpatient clinics. Findings Most clinics had core elements of the people domain of capacity in place. However, the process domain was problematic for many clinics, specifically, capturing problem lists as structured data and having standard processes for maintaining the problem list in the EHR. Also, nearly half of all clinics did not have methods for tracking compliance with their existing processes. Finally, most clinics maintained clinical information in multiple systems, not just the EHR. The most common perceived barriers to MU for eligible professionals included EHR functionality, changes to workflows, increased workload, and resistance to change. Practice Implications Organizational capacity assessments provide a broad institutional perspective and an in-depth clinic-level perspective useful for making resource decisions and tailoring strategies to support the MU change effort for eligible professionals.

Stage 1 of the meaningful use incentive program for electronic health records: a study of readiness for change in ambulatory practice settings in one integrated delivery system

“…Because our recruitment strategy included messages via listserv and the EHR, we were not able to identify the precise number of individuals who received the invitation to participate. However, using data from an inventory of roles collected during a separate study [20], we were able to estimate the number of eligible respondents to be 1,614 and, therefore, a response rate of approximately 25%. The highest percentages of the 400 total responses were from physicians (69.9%), and from individuals that had been in their role for 1-4 years (41.0%), practiced in specialty care clinics (65.5%), and used the EHR 5-7 days per week (86.7%).…”

Brazilian Specialists’ Perspectives on the Patient Referral Process

“…In a study of one regional VA network, despite the EMR, providers reported problems with missed patient test results and subsequent treatment delays [29]. One identified EMR problem was physicians’ capacity to customize results notifications to control for volume overload—introducing human variability and error.…”

Organizational capacity for change in health care

“…Previous health care studies have utilized this concept to help review capacity for health policy organizations to use research evidence (Catallo & Sidani, 2014), organizational capacity to deliver health literacy interventions (Willis et al, 2014), and organizational capacity to achieve meaningful use of an electronic health record (Shea et al, 2014) to name a few. Each shares component associated with Judge and Douglas_s (2009) definition can be broadly defined as including people, process, and technology resources (Shea et al, 2014). However, as Shea and colleagues (2014) indicate, the health care sector can benefit from a more encompassing, specialized, valid, reliable, and standardized approach to measuring change implementation, which is tailored to the many specific challenges health organizations face.…”

“…The resultant survey is informed by the previous conceptualizations of organizational readiness for change (ORC) and absorptive capacity (ACAP) and measures leadership, specific cultural dimensions, and organizational technologies as important factors to determine organizational capacity for change. The combination of these two concepts is necessary to capture the people, process, and technology components that provide for organizational capacity (Shea et al, 2014).…”