Implementation of a nationwide electronic health record (EHR)

2018 ◽  
Vol 31 (2) ◽  
pp. 116-130 ◽  
Author(s):  
Leonidas L. Fragidis ◽  
Prodromos D. Chatzoglou
Keyword(s):  
Best Practices ◽  
Electronic Health Record ◽  
Success Factors ◽  
Implementation Process ◽  
Success Factor ◽  
Health Record ◽  
System Implementation ◽  
Content Type ◽  
Electronic Health ◽  
Specific Implementation

Purpose The purpose of this paper is to identify the best practices applied during the implementation process of a national electronic health record (EHR) system. Furthermore, the main goal is to explore the knowledge gained by experts from leading countries in the field of nationwide EHR system implementation, focusing on some of the main success factors and difficulties, or failures, of the various implementation approaches. Design/methodology/approach To gather the necessary information, an international survey has been conducted with expert participants from 13 countries (Denmark, Austria, Sweden, Norway, the UK, Germany, the Netherlands, Switzerland, Canada, the USA, Israel, New Zealand and South Korea), who had been playing varying key roles during the implementation process. Taking into consideration that each system is unique, with each own (different) characteristics and many stakeholders, the methodological approach followed was not oriented to offer the basis for comparing the implementation process, but rather, to allow us better understand some of the pros and cons of each option. Findings Taking into account the heterogeneity of each country’s financing mechanism and health system, the predominant EHR system implementation option is the middle-out approach. The main reasons which are responsible for adopting a specific implementation approach are usually political. Furthermore, it is revealed that the most significant success factor of a nationwide EHR system implementation process is the commitment and involvement of all stakeholders. On the other hand, the lack of support and the negative reaction to any change from the medical, nursing and administrative community is considered as the most critical failure factor. Originality/value A strong point of the current research is the inclusion of experts from several countries (13) spanning in four continents, identifying some common barriers, success factors and best practices stemming from the experience obtained from these countries, with a sense of unification. An issue that should never be overlooked or underestimated is the alignment between the functionality of the new EHR system and users’ requirements.

scholarly journals Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Ann Scheck McAlearney ◽  
Cynthia Sieck ◽  
Jennifer Hefner ◽  
Julie Robbins ◽  
Timothy R. Huerta
Keyword(s):  
Electronic Health Record ◽  
Resistance To Change ◽  
Implementation Process ◽  
Unintended Consequences ◽  
Successful Implementation ◽  
Health Record ◽  
System Implementation ◽  
Healthcare Organizations ◽  
Record System ◽  
Electronic Health

Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems.Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices.Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods.Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system.Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.

scholarly journals Drivers of expectations: Why are Norwegian general practitioners skeptical of a prospective electronic health record?

2021 ◽  
Vol 27 (1) ◽  
pp. 146045822098729
Author(s):  
Morten Hertzum ◽  
Gunnar Ellingsen ◽  
Line Melby
Keyword(s):  
Electronic Health Record ◽  
General Practitioners ◽  
Current System ◽  
Implementation Process ◽  
Health Record ◽  
Early Implementation ◽  
Ehr Adoption ◽  
Electronic Health

While expectations are well-known drivers of electronic health record (EHR) adoption, the drivers of expectations are more elusive. On the basis of interviews with general practitioners (GPs), we investigate how the early implementation process drives their expectations of an EHR that is being implemented in Norway. The GPs’ expectations of the prospective EHR are driven by (a) satisfying experiences with their current system, (b) the transfer of others’ experiences with the prospective EHR, (c) a sense of alignment, or lack thereof, with those in charge of the implementation process, (d) uncertainty about the inclusion of GP needs, and (e) competing technological futures. To manage expectations, starting early is important. Mismanaged expectations produce a need for convincing people to reverse their expectations. This appears to be the situation in Norway, where the GPs are currently skeptical of the prospective EHR.

scholarly journals Health System Implementation of a Tobacco Quitline eReferral

2019 ◽  
Vol 10 (04) ◽  
pp. 735-742 ◽  
Author(s):  
Eve Angeline Hood-Medland ◽  
Susan L. Stewart ◽  
Hien Nguyen ◽  
Mark Avdalovic ◽  
Scott MacDonald ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Best Practice ◽  
Health Record ◽  
System Implementation ◽  
Electronic Health Record Data ◽  
Outpatient Group ◽  
Primary Care Specialty ◽  
Electronic Health ◽  
Order Set

Abstract Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.

Proposing an Intelligent Cloud-Based Electronic Health Record System

2012 ◽  
Vol 8 (3) ◽  
pp. 57-71 ◽  
Author(s):  
Lara Khansa ◽  
Jonathan Forcade ◽  
Girivaraprasad Nambari ◽  
Saravanan Parasuraman ◽  
Patrick Cox
Keyword(s):  
Best Practices ◽  
Electronic Health Record ◽  
Service Level ◽  
Health Record ◽  
Healthcare Organizations ◽  
Privacy And Security ◽  
Private Patient ◽  
Record System ◽  
Electronic Health ◽  
Reducing Costs

With the aging United States population, healthcare costs have considerably increased and are expected to keep rising in the foreseeable future. In this paper, the authors propose an intelligent cloud-based electronic health record (ICEHR) system that has the potential to reduce medical errors and improve patients’ quality of life, in addition to reducing costs and increasing the productivity of healthcare organizations. They developed a set of best practices that encompass end-user policies and regulations, identity and access management, network resilience and service level agreements, advanced computational power, “Big Data” mining abilities, and other operational/managerial controls that are meant to improve the privacy and security of the ICEHR, and make it inherently compliant to healthcare regulations. These best practices serve as a framework that offers a single interconnection agreement between the cloud host and healthcare entities, and streamlines access to private patient information based on a unified set of access principles.

scholarly journals Desiderata for the development of next-generation electronic health record phenotype libraries

GigaScience ◽  
2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Martin Chapman ◽  
Shahzad Mumtaz ◽  
Luke V Rasmussen ◽  
Andreas Karwath ◽  
Georgios V Gkoutos ◽  
...  
Keyword(s):  
Best Practices ◽  
Electronic Health Record ◽  
Health Record ◽  
Next Generation ◽  
Electronic Health Record Data ◽  
High Quality ◽  
Record Data ◽  
Electronic Health ◽  
Further Development

Abstract Background High-quality phenotype definitions are desirable to enable the extraction of patient cohorts from large electronic health record repositories and are characterized by properties such as portability, reproducibility, and validity. Phenotype libraries, where definitions are stored, have the potential to contribute significantly to the quality of the definitions they host. In this work, we present a set of desiderata for the design of a next-generation phenotype library that is able to ensure the quality of hosted definitions by combining the functionality currently offered by disparate tooling. Methods A group of researchers examined work to date on phenotype models, implementation, and validation, as well as contemporary phenotype libraries developed as a part of their own phenomics communities. Existing phenotype frameworks were also examined. This work was translated and refined by all the authors into a set of best practices. Results We present 14 library desiderata that promote high-quality phenotype definitions, in the areas of modelling, logging, validation, and sharing and warehousing. Conclusions There are a number of choices to be made when constructing phenotype libraries. Our considerations distil the best practices in the field and include pointers towards their further development to support portable, reproducible, and clinically valid phenotype design. The provision of high-quality phenotype definitions enables electronic health record data to be more effectively used in medical domains.

scholarly journals Essential activities for electronic health record safety: A qualitative study

2019 ◽  
Vol 26 (4) ◽  
pp. 3140-3151 ◽  
Author(s):  
Joan S Ash ◽  
Hardeep Singh ◽  
Adam Wright ◽  
Dian Chase ◽  
Dean F Sittig
Keyword(s):  
Best Practices ◽  
Electronic Health Record ◽  
Rapid Assessment ◽  
Clinical Decision ◽  
Assessment Process ◽  
Health Record ◽  
Healthcare Organizations ◽  
Safety Risks ◽  
Electronic Health ◽  
Clinical Systems

Electronic health record-caused safety risks are an unintended consequence of the implementation of clinical systems. To identify activities essential to assuring that the electronic health record is managed and used safely, we used the Rapid Assessment Process, a collection of qualitative methods. A multidisciplinary team conducted visits to five healthcare sites to learn about best practices. Although titles and roles were very different across sites, certain tasks considered necessary by our subjects were remarkably similar. We identified 10 groups of activities/tasks in three major areas. Area A, decision-making activities, included overseeing, planning, and reviewing to assure electronic health record safety. Area B, organizational learning activities, involved monitoring, testing, analyzing, and reporting. Finally, Area C, user-related activities, included training, communication, and building clinical decision support. To minimize electronic health record-related patient safety risks, leaders in healthcare organizations should ensure that these essential activities are performed.

Critical success factors for TQM implementation among manufacturing SMEs

2019 ◽  
Vol 27 (2) ◽  
pp. 473-498 ◽  
Author(s):  
Svetoslav Georgiev ◽  
Seiichi Ohtaki
Keyword(s):  
Success Factors ◽  
Implementation Process ◽  
International Study ◽  
Shop Floor ◽  
Success Factor ◽  
Total Quality ◽  
Structured Interviews ◽  
Content Type ◽  
Critical Success ◽  
Management Involvement

Purpose The purpose of this paper is to address a perennial question regarding the importance of soft total quality management (TQM) as part of the TQM implementation process – a topic that has been significantly understudied. Specifically, the authors address previous calls in the literature for stressing the soft aspects of TQM and for drawing a critical success factor (CSF) list that is formulated on the basis of empirical research instead of theory. Design/methodology/approach This is a comparative qualitative case study of three manufacturing SMEs combining empirical data from in-depth, semi-structured interviews with a large variety of stakeholders – from top managers to shop-floor workers, site visits and observations. Findings The study identifies 12 soft CSFs, and while most of these factors have been well-documented in the literature (e.g. top management involvement and leadership), the authors show evidence for the existence of other soft constructs that have not been considered or have been given little importance previously (i.e. middle management involvement and support, reward and recognition, CSR focus). Research limitations/implications The study fills two major gaps in the (T)QM literature. First, it enriches the understanding of TQM implementation among Japanese SMEs. Second, it addresses the importance of soft TQM as part of the TQM implementation process. Practical implications This paper provides company owners and managers with valuable knowledge that may assist their organisations in the pursuit of business excellence including higher product quality and employee satisfaction. Originality/value To the authors’ knowledge, this is the first (international) study to investigate TQM implementation within the context of Japanese SMEs.

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