Building a Comprehensive Clinical Information System from Components

Borbolla

et al. 2019

eGEMs

Objective: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research. Methods: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation. Fourteen interviews were recorded and transcribed. Three authors independently coded interview narratives and via consensus identified factors contributing to changes on 15 outcomes of quality, productivity, and safety. Results: We identified 14 factors that potentially affected the outcomes previously monitored. Our findings demonstrate that several factors related to the implementation (e.g., incomplete data migration), partially related (e.g., intentional decrease in volume of work), and not related (e.g., health insurance changes) may affect outcomes in different ways. Discussion: This is the first study to investigate factors contributing to changes on a broad set of quality, productivity, and safety outcomes during an EHR implementation guided by the results of a large longitudinal evaluation. The diversity of factors identified indicates that the need for organizational adaptation to take full advantage of new technologies is as important for health care as it is for other services sectors. Conclusions: We recommend continuous identification and monitoring of these factors in future evaluations to hopefully increase our understanding of the full impact of health information technology interventions.

Section: Methodsmentioning

confidence: 99%

Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation

Borbolla

et al. 2019

eGEMs

Learning Health Systems

Better together: Integrating biomedical informatics and healthcare IT operations to create a learning health system during the COVID‐19 pandemic

Payne

Wilcox

Embí

et al. 2022

The growing availability of multi‐scale biomedical data sources that can be used to enable research and improve healthcare delivery has brought about what can be described as a healthcare “data age.” This new era is defined by the explosive growth in bio‐molecular, clinical, and population‐level data that can be readily accessed by researchers, clinicians, and decision‐makers, and utilized for systems‐level approaches to hypothesis generation and testing as well as operational decision‐making. However, taking full advantage of these unprecedented opportunities presents an opportunity to revisit the alignment between traditionally academic biomedical informatics (BMI) and operational healthcare information technology (HIT) personnel and activities in academic health systems. While the history of the academic field of BMI includes active engagement in the delivery of operational HIT platforms, in many contemporary settings these efforts have grown distinct. Recent experiences during the COVID‐19 pandemic have demonstrated greater coordination of BMI and HIT activities that have allowed organizations to respond to pandemic‐related changes more effectively, with demonstrable and positive impact as a result. In this position paper, we discuss the challenges and opportunities associated with driving alignment between BMI and HIT, as viewed from the perspective of a learning healthcare system. In doing so, we hope to illustrate the benefits of coordination between BMI and HIT in terms of the quality, safety, and outcomes of care provided to patients and populations, demonstrating that these two groups can be “better together.”

IFIP — The International Federation for Information Processing

The Slight Surprise of Integration

Ellingsen

Monteiro

A b s t r a c tWestern hospitals of some size are characterized by a proliferation of nonintegrated information systems, resulting in considerable frustration both among users and information technology personnel Consequently there have been many integration efforts. Such efforts typically include some or all of the four principle classes of hospital-based systems: electronic patient records, laboratory systems, radiology systems and patient administrative systems. In this study, we trace the implementation process during most of 2004 at the University Hospital of North Norway, where these systems were part of a larger replacement project. We analyze the images and visions of order and perfection serving as a foundation for the decision to replace the existing IT portfolio. Furthermore, we analyze the manner and form in which unintended consequences of the integrated solutions appear and, finally, how the very act of integration may indeed produce rather than curb disorder. As a result, a lack of integration of any reasonably complex information system is an immanent feature. K e y w o r d s Hospital information systems, EPR, integration, order perfectionPart 4: Development Issues