Understanding key factors affecting electronic medical record implementation: a sociotechnical approach

Cucciniello, Maria; Lapsley, Irvine; Nasi, Greta; Pagliari, Claudia

doi:10.1186/s12913-015-0928-7

Cited by 57 publications

(62 citation statements)

References 41 publications

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“…The hospitals participating in this study offer nurses support and help in the event they encounter difficulties with SCP individualisation. As shown in other studies, the most valued figure for nurses is the knowledge and information system nurses (Cucciniello, Lapsley, Nasi, & Pagliari, 2015). These expert nurses in clinical knowledge, nursing methodology and EHR management either provide help by telephone or they go to the ward in person.…”

Section: Discussionmentioning

confidence: 86%

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

Castellà-Creus

Delgado‐Hito

Casanovas-Cuellar

et al. 2019

Journal of Clinical Nursing

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Objective To identify and classify the barriers and facilitators of the individualisation process of the standardised care plan in hospitalisation wards. Background The administration of individualised care is one of the features of the nursing process. Care plans are the structured record of the diagnosis, planning and evaluation stages of the nursing process. Although the creation of standardised care plan has made recording easier, it is still necessary to record the individualisation of the care. It is important to study the elements that influence the individualisation process from the nurses' perspective. Design Qualitative study with the grounded theory approach developed by Strauss and Corbin. Methods Thirty‐nine nurses from three hospitals participated by way of theoretical sampling. In‐depth interviews were conducted, as well as participant observation, document analysis and focus group discussion. The analysis consisted of open, axial and selective coding until data saturation was reached. EQUATOR guidelines for qualitative research (COREQ) were applied. Results For both barriers and facilitators, three thematic categories emerged related to organisational, professional and individual aspects. The identified barriers included routines acquired in the wards, the tradition of narrative records, lack of knowledge and limited interest in individualisation. The identified facilitators included holding clinical care sessions, use of standardised care plan and an interface terminology, the nurse's expertise and willingness to individualise. Conclusion The individualisation process of the standardised care plan involves multiple barriers and facilitators, which influence its degree of accuracy. Relevance to clinical practice Implementing strategies at an organisational level, professional level and individual level to improve the way the process is carried out would encourage individualising the standardised care plan in a manner that is consistent with the needs of the patient and family; it would improve the quality of care and patient satisfaction.

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Section: Discussionmentioning

confidence: 86%

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

Castellà-Creus

Delgado‐Hito

Casanovas-Cuellar

et al. 2019

Journal of Clinical Nursing

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“…Formal evaluation of organisational readiness for EPR implementation, in terms of culture, leadership, management, technical infrastructure, governance and operational planning improves the chances of success 33. Recognition that EPR will require resourcing of new roles, in addition to investment in mechanisms to assess post-implementation impact are important 34. Finally, there must be understanding of potential gaps in capability system functionality and awareness of important ‘peripheral’ effects, such as impacts on communication 35…”

Section: Resultsmentioning

confidence: 99%

What to expect from electronic patient record system implementation: lessons learned from published evidence

Priestman

Sridharan

Vigne

et al. 2018

BMJ Health Care Inform

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BackgroundNumerous studies have examined factors related to success, failure and implications of electronic patient record (EPR) system implementations, but usually limited to specific aspects.ObjectiveTo review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.MethodLiterature review.ResultsThree hundred and twelve potential articles were identified on initial search, of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation and screening performance and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.ConclusionThe findings presented here represent the synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system.

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“…Fullerton et al (2006); Gagnon et al (2012); Keshavjee et al (2006); Ovretveit et al (2007); and Simon et al (2013) have all illustrated that the involvement of EHRS end-users from various departments and occupations is essential to successful implementation. Therefore, implementation can be improved through consideration of the needs and requirements of every end-user (Cucciniello et al, 2015;Hartzler et al, 2013;McAlearney et al, 2013;Ross et al, 2016).…”

Section: Ehrs End-user Involvementmentioning

confidence: 99%

“…In the same context, in order to achieve smooth implementation, stakeholders need to be informed about the EHRS implementation process, including any future modifications to the system (Cucciniello et al, 2015;Gagnon et al, 2016). Moreover, to avoid any resistance, end-users should be treated as owners of the EHRS during the implementation (Boonstra et al, 2014;Gagnon et al, 2012).…”

Section: Ehrs End-user Involvementmentioning

confidence: 99%

“…Previous literature has recommended defining specific time scales to involve EHRS endusers. While some researchers suggested involving EHRS end-users in the evaluation and readiness assessment (Cucciniello et al, 2015;Hartzler et al, 2013), others have suggested including them in the pre-implementation (e.g., planning) phase of the project (Ghazisaeidi et al, 2014). However, EHRS end-user involvement must be continuous and not confined to certain stages.…”

Section: Ehrs End-user Involvementmentioning

confidence: 99%

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

Alzghaibi¹

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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

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Understanding key factors affecting electronic medical record implementation: a sociotechnical approach

Cited by 57 publications

References 41 publications

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

Barriers and facilitators involved in standardised care plan individualisation process in acute hospitalisation wards: A grounded theory approach

What to expect from electronic patient record system implementation: lessons learned from published evidence

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

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