Journal Article•
Electronic Health Record Implementation: A SWOT Analysis
TL;DR: The highest priority in strength analysis was related to timely and quick access to information, but lack of hardware and infrastructures was the most important weakness and the most substantial threats were the lack of strategic planning in the field of electronic health records.
Abstract: Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians' and other clinical staff's resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation.
Citations
More filters
04 Nov 2010
TL;DR: In this article, the authors analyzed the workflow and implementation of EHR systems across different functions in small physician offices based on a combination of questionnaires, interviews, in situ observations, and data collection efforts.
Abstract: This paper analyzes the workflow and implementation of electronic health record (EHR) systems across different functions in small physician offices. We characterize the differences in the offices based on the levels of computerization in terms of workflow, sources of time delay, and barriers to using EHR systems to support the entire workflow. The study was based on a combination of questionnaires, interviews, in situ observations, and data collection efforts. This study was not intended to be a full-scale time-and-motion study with precise measurements but was intended to provide an overview of the potential sources of delays while performing office tasks. The study follows an interpretive model of case studies rather than a large-sample statistical survey of practices. To identify time-consuming tasks, workflow maps were created based on the aggregated data from the offices. The results from the study show that specialty physicians are more favorable toward adopting EHR systems than primary care physicians are. The barriers to adoption of EHR systems by primary care physicians can be attributed to the complex workflows that exist in primary care physician offices, leading to nonstandardized workflow structures and practices. Also, primary care physicians would benefit more from EHR systems if the systems could interact with external entities.
44 citations
TL;DR: As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes.
Abstract: The use of artificial intelligence (AI) to support clinical medical decisions is a rather promising concept. There are two important factors that have driven these advances: the availability of data from electronic health records (EHR) and progress made in computational performance. These two concepts are interrelated with respect to complex mathematical functions such as machine learning (ML) or neural networks (NN). Indeed, some published articles have already demonstrated the potential of these approaches in medicine. When considering the diagnosis and management of pneumonia, the use of AI and chest X-ray (CXR) images primarily have been indicative of early diagnosis, prompt antimicrobial therapy, and ultimately, better prognosis. Coupled with this is the growing research involving empirical therapy and mortality prediction, too. Maximizing the power of NN, the majority of studies have reported high accuracy rates in their predictions. As AI can handle large amounts of data and execute mathematical functions such as machine learning and neural networks, AI can be revolutionary in supporting the clinical decision-making processes. In this review, we describe and discuss the most relevant studies of AI in pneumonia.
26 citations
TL;DR: The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence and individual ones) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention toUse EMRS.
Abstract: The implementation of hospital-wide Electronic Medical Records (EMRs) is still an unsolved quest for many hospital managers. EMRs have long been considered a key factor for improving healthcare quality and safety, reducing adverse events for patients, decreasing costs, optimizing processes, improving clinical research and obtaining best clinical performances. However, hospitals continue to experience resistance from professionals to accepting EMRs. This study combines institutional and individual factors to explain which determinants can trigger or inhibit the EMRs implementation in hospitals, and which variables managers can exploit to guide professionals' behaviours. Data have been collected through a survey administered to physicians and nurses in an Italian University Hospital in Rome. A total of 114 high-quality responses had been received. Results show that both, physicians and nurses, expect many benefits from the use of EMRs. In particular, it is believed that the EMRs will have a positive impact on quality, efficiency and effectiveness of care; handover communication between healthcare workers; teaching, tutoring and research activities; greater control of your own business. Moreover, data show an interplay between individual and institutional determinants: normative factors directly affect perceived usefulness (C = 0.30 **), perceived ease of use (C = 0.26 **) and intention to use EMRs (C = 0.33 **), regulative factors affect the intention to use EMRs (C = -0.21 **), and perceived usefulness directly affect the intention to use EMRs (C = 0.33 **). The analysis carried out shows that the key determinants of the intention to use EMRs are the normative ones (peer influence) and the individual ones (perceived usefulness), and that perceived usefulness works also as a mediator between normative factors and intention to use EMRs. Therefore, Management can leverage on power users to motivate, generate and manage change.
22 citations
TL;DR: In this article, the authors discuss the partizipative Entwicklung and Implementierung of Interventionen mit digitalen in the Bereich Digital Public Health (DPH).
Abstract: Zwischen (digitalen) Technologien und der Gesellschaft bestehen dynamische Wechselbeziehungen. Digitale Technologien wirken dabei in vielfaltiger Weise (re)strukturierend auf soziale Zusammenhange und soziale Innovationen. Aufgrund dieser Charakteristik beruhren technologische Innovationen unsere individuellen Lebensstile und Lebenswelten. Insbesondere die Entwicklung und Implementierung von Interventionen mit digitalen (Gesundheits‑)Technologien erfahren national und international eine zunehmende Aufmerksamkeit (z. B. telemedizinische Hausarztsprechstunde, app-gestutzte Patientenedukationsprogramme). Digitale Gesundheitstechnologien ermoglichen neue Interaktions- und wissensbezogene Reproduktionsformen im Bereich Gesundheit. Die Einbindung potenzieller Nutzer*innen in den Entwicklungsprozess digitaler Gesundheitstechnologien und -interventionen erfordert die Diskussion neuer wissenschaftlicher Methoden. Interessen, Bedarfe und Bedurfnisse der Nutzer*innen konnen zur Nichtnutzung digitaler Gesundheitstechnologien fuhren. Vor allem die erfolgreiche Implementierung, unter der Einbindung von potenziell Nutzenden, kann einen Einfluss auf die Akzeptanz und integrative Nutzung im spateren Versorgungsverlauf haben. Der Diskurs uber die partizipative Entwicklung und Implementierung von Interventionen mit digitalen Gesundheitstechnologien im Bereich Digital Public Health stellt sich als komplexer Prozess dar, welcher durch verschiedene theoretische Ansatze und methodisches Vorgehen charakterisiert ist und eine Darstellung, Bewertung und Einordnung erfordert.
13 citations
TL;DR: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability) so practitioners and administrators should focus on the former 2 factors because they are within their sphere of control.
Abstract: Background Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820 International Registered Report Identifier (IRRID) RR2-10.2196/15490
12 citations
References
More filters
TL;DR: The potential benefits of EHRs that include clinical outcomes, organizational outcomes, financial and operational benefits, and societal outcomes are described, which include improved ability to conduct research, improved population health, reduced costs.
Abstract: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the “stimulus package” represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way.
606 citations
"Electronic Health Record Implementa..." refers background in this paper
...It can also have the potential to transform the healthcare system from a mostly paper-based industry to one that utilizes multiple sets of information to assist providers in delivering a higher quality of care to their patients (5)....
[...]
TL;DR: This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users to demonstrate that each user group has a unique perspective of the implementation process that should be taken into account.
Abstract: Electronic health record (EHR) implementation is currently underway in Canada, as in many other countries. These ambitious projects involve many stakeholders with unique perceptions of the implementation process. EHR users have an important role to play as they must integrate the EHR system into their work environments and use it in their everyday activities. Users hold valuable, first-hand knowledge of what can limit or contribute to the success of EHR implementation projects. A comprehensive synthesis of EHR users' perceptions is key to successful future implementation. This systematic literature review was aimed to synthesize current knowledge of the barriers and facilitators influencing shared EHR implementation among its various users. Covering a period from 1999 to 2009, a literature search was conducted on nine electronic databases. Studies were included if they reported on users' perceived barriers and facilitators to shared EHR implementation, in healthcare settings comparable to Canada. Studies in all languages with an empirical study design were included. Quality and relevance of the studies were assessed. Four EHR user groups were targeted: physicians, other health care professionals, managers, and patients/public. Content analysis was performed independently by two authors using a validated extraction grid with pre-established categorization of barriers and facilitators for each group of EHR users. Of a total of 5,695 potentially relevant publications identified, 117 full text publications were obtained after screening titles and abstracts. After review of the full articles, 60 publications, corresponding to 52 studies, met the inclusion criteria. The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities. This systematic review presents innovative research on the barriers and facilitators to EHR implementation. While important similarities between user groups are highlighted, differences between them demonstrate that each user group also has a unique perspective of the implementation process that should be taken into account.
346 citations
"Electronic Health Record Implementa..." refers background in this paper
...Lack of time and increase of workload are the concerns that are stated in McGinn’s study (24) while user resistance is a barrier that has been reported in some other articles (25)....
[...]
01 Jul 2012
TL;DR: Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments.
Abstract: An examination of nine hospitals that recently implemented a comprehensive electronic health record (EHR) system finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. Successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget. The EHR systems facilitate patient safety and quality improvement through: use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports. Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments.
205 citations
"Electronic Health Record Implementa..." refers background in this paper
...Lack of time and increase of workload are the concerns that are stated in McGinn’s study (24) while user resistance is a barrier that has been reported in some other articles (25)....
[...]
...The ability to manage change in an organization (30), staff workload balance (34), clear definition of roles, identification of stockholders’ demands (35), preparation of a strategic plan (25), and identification of the needed financial and human recourses (36) are the most important factors that must be considered....
[...]
TL;DR: It is argued that two salient physician identities, those of careprovider and physician community, grounded in the roles physicians play and the groups with which they affiliate, manifest as both identity reinforcement and deterioration, and are important drivers of EHRS assimilation.
Abstract: With the lack of timely and relevant patient information at the point of care increasingly being linked to adverse medical outcomes, effective management and exchange of patient data has emerged as a strategic imperative for the healthcare industry. Healthcare informaticians have suggested that electronic health record systems (EHRS) can facilitate information sharing within and between healthcare stakeholders such as physician practices, hospitals, insurance companies, and laboratories. We examine the assimilation of EHRS in physician practices through a novel and understudied theoretical lens of physicians' identities. Physician practices and the physicians that lead them occupy a central position in the healthcare value chain and possess a number of unique characteristics that differentiate them from other institutional contexts, including a strong sense of affiliation with other physicians, potent professional identities, and a desire for autonomy. We investigate two salient physician identities, thos...
115 citations
"Electronic Health Record Implementa..." refers background in this paper
...The ability to manage change in an organization (30), staff workload balance (34), clear definition of roles, identification of stockholders’ demands (35), preparation of a strategic plan (25), and identification of the needed financial and human recourses (36) are the most important factors that must be considered....
[...]
TL;DR: The analysis of national electronic health record programs from England, Germany, Canada, Denmark and Australia shows that similar critical areas exist in the various countries and it would be desirable to set up a comprehensive method that provides support in the complete process of implementing national electronichealth record programs.
100 citations
"Electronic Health Record Implementa..." refers background in this paper
...Deutsch believes that preparing a strategic plan in EHR pre-implementation phase is essential (30)....
[...]
...The ability to manage change in an organization (30), staff workload balance (34), clear definition of roles, identification of stockholders’ demands (35), preparation of a strategic plan (25), and identification of the needed financial and human recourses (36) are the most important factors that must be considered....
[...]