Mind the Gap

Abstract

SummaryObjective: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results: We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion: Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion: Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. Citation: Ratwani R et al.: Review to identify usability and safety challenges and practices during EHR implementation.

Successfully implementing a national electronic health record: a rapid umbrella review

“…The governance of the EHR implementation 13 , 19 , 37 , as well as leaders 7 , 10 , 36 , 44 , 48 , [52] , [53] , [54] , 62 , 63 and organizational culture, were identified as paramount in ensuring a successful EHR system 7 , 10 , 13 , 36 , 45 , [50] , [51] , [52] , [53] , 56 , 59 , 62 . Whilst top-down, middle-out and bottom-up governance structures have been utilised, ongoing political willingness, national policies and some independence at an individual organizational level regarding EHR procurement, development and design, were recommended to promote engagement, usability and interoperability 13 , 48 , 51 , 62 .…”

“…An initial exploratory scope of the EHR literature in the PubMed database was reviewed by the expert panel and the final research question, methodology and search strategy were developed and agreed. A large number of search terms to describe “Electronic Health Record”, “Implementation” and “ Literature Review” were identified from previous systematic reviews 7 , [36] , [37] , [38] , [39] , [40] , additional literature 17 , medical subject heading and controlled vocabulary and via consultation with the expert panel and an experienced information technologist at the Health Sciences Library, UCD [Appendix]. The search string was tailored to the indexing language of each database and in March 2019, it was executed across PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest and Cochrane, with limitations of English language and published since 2010.…”

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative

“…The effect of these core components is strengthened by performance review meetings that unify multiple health system levels (provincial, district, facility, and community) to assess data quality, highlight areas of weakness, and plan improvements. Other studies have demonstrated that with adequate financial and human resources, implementation of EMR systems can accelerate and systematize data feedback loops to core stakeholders, such as is the case in Rwanda [ 33 ]. In the three PHIT projects involved in this study, intervention components that aligned with user priorities and government systems were perceived to be relatively advantageous, and more readily adapted and adopted, which will facilitate efforts to sustain and spread data quality improvements.…”

Chinese Mobile Health APPs for Hypertension Management: A Systematic Evaluation of Usefulness

“…As a major research target in the field of HCI, usability refers to how useful, usable, and satisfying a system is for the intended users to accomplish goals in the work domain by performing certain sequences of tasks [9]. TURF, as one of the major and mainstream methods for usability evaluation, is a theoretical framework that assesses the usability of EHRs from three dimensions, including usefulness, usability, and user satisfaction [9–11].…”

“…TURF, as one of the major and mainstream methods for usability evaluation, is a theoretical framework that assesses the usability of EHRs from three dimensions, including usefulness, usability, and user satisfaction [9–11]. According to the definitions of TURF, the usability evaluation of eHealth products is divided into degree of inherent complexity (usefulness) and degree of exogenous complexity (usability and satisfaction) [10, 11].…”