Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients

Butler-Henderson

2020

BMJ Health Care Inform

IntroductionElectronic health records (EHRs) can improve the quality and safety of care. However, the adoption and use of the EHR is influenced by several factors, including users’ perception.ObjectivesTo undertake a systematic review of the literature to understand healthcare professionals’ perceptions about the adoption and use of EHRs in Gulf Cooperation Council (GCC) countries in order to influence the implementation strategies, training programme and policy development in the GCC region.MethodA systematic literature search was undertaken on seven online databases to identify articles published between January 2006 and December 2017 examining healthcare professionals’ perception towards the adoption and use of EHR in the Gulf context.ResultsThe fourteen articles included in this review identified both positive and negative perceptions of the role of EHR in healthcare. The positive perceptions included EHR benefits, such as improvements to work efficiency, quality of care, communication and access to patient data. Conversely, the negative perceptions were associated with challenges or risks of adopting an EHR, such as disruption of provider–patient communication, privacy and security concerns and high initial costs. The perceptions were influenced by personal factors (eg, age, occupation and computer literacy) and system factors (perceived usefulness and perceived ease of use).ConclusionPositive perceptions of EHRs by the healthcare professionals could facilitate the adoption of this technology in the Gulf region, particularly when barriers are addressed early. Negative perceptions may inform change management strategies during adoption and implementation. The perceptions should be further evaluated from a technology acceptance perspective.

Section: Discussionsupporting

confidence: 87%

Perceptions of healthcare professionals about the adoption and use of EHR in Gulf Cooperation Council countries: a systematic review

Butler-Henderson

2020

BMJ Health Care Inform

“…A major contextual issue that affects success is the scope and complexity of the project, and this was shown in the two case studies. Duartea and Azevedo evaluated the satisfaction and expectations of patients and physicians before and after an EHR implementation in a university hospital in Brazil. Their results reinforced the idea that EHR introduction in a clinical setting should be preceded by careful planning to improve physicians' adherence to using EHR.…”

Section: Literature Reviewmentioning

confidence: 99%

“…In conclusion, most of the related works consider different ICT aspects in the health care domain but not the reasons for implementation failure. These aspects include technology acceptance/adoption, patient satisfaction/participation, and smartphone/cloud‐based applications . Other works have focused on the financial impact of EHR on hospitals .…”

Section: Literature Reviewmentioning

confidence: 99%

Healthcare software design and implementation—A project failure case

Ebad

2020

Softw Pract Exp

Electronic health records (EHRs) are implemented by many health care organizations as a potential service solution. Despite the appeal of EHRs, failure in their implementation can lead to negative consequences, ranging from the loss of money to reputation damage, for health care providers. However, the causes of this problem have not attracted the attention of a sufficient number of researchers. This paper aims to investigate this phenomenon objectively and subjectively in a public context using an interview-based qualitative approach supported by archival data and records of a real-world failed EHR project. The results show that the factors influencing failure are divergent and include technical and managerial issues. In particular, the timing and duration of the training as well as the integration of EHR with the enterprise systems were found to be the strongest influencing factors, followed by reasons related to the software design (eg, a lack of required pharmacy functionality) and software people management (eg, resistance to change). The paper also discusses points related to EHR development and design, such as the development paradigm, data quality and validation, architecture for security, and source code naming convention. K E Y W O R D S electronic health record, software design, software project management, failure, software security 1 1258 1259While increased adoption and growth of EHR have been observed, there is a surprising lack of studies regarding the reasons why EHR implementation fails. Such studies could help prevent past implementation mistakes and reduce the overall risk involved in implementation. The benefits of EHR, if it is properly implemented, are far more substantial than the risks. The benefits include higher patient and doctor satisfaction, real-time information tracking, fewer handwritten forms, fewer preventable errors, fewer dosage errors, and increased quality of care. 6,7 However, due to several factors, including technological barriers and poor infrastructure, these benefits are not always achieved, especially in developing countries. 8 Additionally, each health service has particularities that should be considered to facilitate adoption. 9 Adoption may involve diverse changes in the different phases of the work of health professionals. Once EHR is implemented, the process is continually changing and evolving. EHR implementation is thus a challenging development stage, especially in developing countries characterized by a lack of information and communication technology (ICT) adoption. 8,10 The consequences of implementation failure not only affect patient satisfaction but also can cause tremendous economic loss and reputation damage for health care providers.The contribution of our study is the identification of the reasons for EHR implementation failure in real-world environments. To the best of our knowledge, this area has received less research attention than different aspects related to EHR systems. 1,6,[11][12][13][14] Conducting such real-world-based studies is harder i...

“…Similar studies have also utilised semi-structured interviews to explore the implementation of EHRS in different healthcare organisations and countries (e.g. Alkraiji et al, 2013;Ash et al, 2003;Boyer et al, 2010;Cresswell et al, 2012;Godoy & Soares, 2017;McAlearney et al, 2014;McAlearney et al, 2013;Terry et al, 2009). Although, semi-structured interviews have not been the most favoured or frequently used approach for other research (see Chapter Two), the above-mentioned researchers were able to provide a detailed description and explanation of EHRS implementation.…”

Section: Data Collection Via Semi-structured Interviewsmentioning

confidence: 99%

“…Contrary to expectations, with the exception of end-user occupation, this research did not find a significant difference between user demographics with regards to their satisfaction. With regards to the age of end-users, various studies have argued that older users show less satisfaction with an EHRS than younger users (Al Alawi et al, 2014;Decker et al, 2012;Duarte & Azevedo, 2017;Hamid & Cline, 2013;Kang & Yoon, 2008;Moody et al, 2004;Urban et al, 2012;Ziefle & Bay, 2005). In contrast, other research has revealed that older EHRS end-users were found to be more positive about EHRS implementation and usage than younger users (Alasmary et al, 2014;Khajouei et al, 2011;Khalifa & Alswailem, 2015).…”

Section: The Impact Of Ehrs End-user Demographic Differences On Theirmentioning

confidence: 99%

Implementing a Large-scale Electronic Health Record System in the Primary Healthcare Centres in Saudi Arabia

Alzghaibi¹

There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organisations. This move to ehealth transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges. There has been no previous research that has explored the implementation of an EHRS in Primary Healthcare Centres (PHCs). In addition, barriers and facilitators to the implementation of large-scale EHRS in PHCs are not well defined and there is little known about the impact of Financial Resources (FR) and Centralised Management (CM) on such implementation. Thus, this thesis aims to explore the large-scale implementation of EHRS in PHCs in Saudi Arabia (SA). To achieve this aim, a mixed-methods approach comprising both quantitative and qualitative methods was adopted. Data were collected via questionnaire-based studies and semistructured interviews. Three different populations were targeted: project team members, PHC staff, and EHRS end-users. Descriptive and inferential statistics were applied to the quantitative data, and thematic analysis was used to analyse the qualitative data. The findings revealed high PHCs readiness at the organisational and individual level when compared with the technological level. Both FR and CM were documented to have a positive impact on the implementation of a large scale EHRS. Several facilitators to the implementation of the EHRS were identified, including: strong leadership and appropriate management, PHC specifications, system usability, perceived usefulness and efficiency. The scale of the project, shortage in Health Informatics (HI) expertise, lack of training and support, geographic challenges, software selection and end-user involvement were identified as the main barriers to implementing a large-scale EHRS in the PHCs. No relationships were detected between individual demographic differences, such as age and gender, and level of readiness or satisfaction. Based on the Saudi experience, there may be some important transferable lesson for similar projects elsewhere. Large-scale EHRS projects need to adopt CM. In addition, due to shortage in HI expertise, policymakers may need to carry out some consultations to formulate good implementation plane. Largescale projects also need to be implemented by more than one vendor and include training and technical support to increase end-user satisfaction. Inadequate infrastructure, lack of interoperability, changing executives and lack of technical support were the main possible causes to the failure of large-scale EHRS projects. Implementation needs to ensure sufficient budget and time have been allocated to mitigate the challenges identified. III DECLARATION