Staff expectations for the implementation of an electronic health record system: A qualitative study using Normalisation Process Theory

Abstract

Background Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. Methods Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. Results Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. Conclusions Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.

Protocol for a qualitative study to explore acceptability, barriers and facilitators of the implementation of new teleophthalmology technologies between community optometry practices and hospital eye services

“…NPT is concerned with understanding and explaining factors that may facilitate or inhibit the incorporation of complex interventions into routine practice 38 39. NPT focuses on understanding the work that individuals and groups need to do for a complex intervention to become ‘normalised’ and embedded in practice, particularly in a healthcare context 39–42. Thus, a starting point of this theory is understanding current practices, that is, how people work and what they actually do 40.…”

“…NPT comprises four components that determine the normalisation of a complex intervention in practice 39 40. These are: (1) coherence, which refers to participants’ understanding of new technology and practices associated with it; (2) cognitive participation, which refers to the preparedness of participants to engage and use the technology; (3) collective action, which refers to the work that participants do to use the technology and (4) reflective monitoring, which refers to participants’ appraisal of the new technology 23 39 42. There is evidence for the stability and consistency of NPT constructs across various contexts, advocating their use to assess, describe or improve the implementation potential of complex interventions 39 41 43.…”

“…There is evidence for the stability and consistency of NPT constructs across various contexts, advocating their use to assess, describe or improve the implementation potential of complex interventions 39 41 43. NPT has also been used to explore users’, including patients’ and healthcare professionals’, expectations of digital health interventions as well as barriers and facilitators to engaging with these interventions,37 42 44 45 although limited evidence is available on teleophthalmology and AI DSS. In this study, it is envisaged that the use of NPT will help better understand the implementation process of these two technologies in routine practice and identify factors that may contribute to a successful implementation.…”

Persisting workarounds in Electronic Health Record System use: types, risks and benefits

“…When healthcare providers devise such a workaround, system developers become aware of missing elements, can build in the necessary data entry accordingly, and thereby ensure a better fit between the EHR and the healthcare organization [6]. Workarounds can also be conducted as a quick fix of an unusual problem [28] or conceived creatively [29] to contribute to a well-functioning and normalized workflow [23,40]. Healthcare professionals can decide to create workarounds in emergency situations if the EHR system does not recognize such urgency in order to be able to continue tasks they consider crucial [27].…”

Visualizing Benefits: Evaluating Healthcare Information System Using IS-Impact Model

“…Within complex organizational structures, such as in Canadian healthcare authorities, IS solutions are implemented to improve services and support for better healthcare outcomes. However, implementing healthcare information system is complex, and this must be done in an expedient, safe and responsible manner that benefits patients, staff, and the broader organization [2]. In most healthcare organizations, this is done in the context of increasing costs, changing demographics, an aging population and finite resources.…”