User perspectives on barriers to and facilitators of the implementation of electronic health records in behavioral health hospitals: A qualitative study (Preprint)

BACKGROUND Despite the rapid adoption of electronic health records (EHRs) thanks to the reimbursement program of the US government, the adoption of EHRs in behavioral health hospitals continues to lag behind that of other hospitals, and there remains a lack of evidence regarding barriers to and facilitators of the implementation of behavioral healthcare electronic health records (bhEHRs). OBJECTIVE The aim of this study was to analyze the experience of behavioral health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of bhEHRs. METHODS In this qualitative study, we interviewed physicians, nurses, pharmacists, behavioral health clinicians, and administrative professionals separately at 4 behavioral health hospitals in the US. We conducted semistructured interviews (N= 43) at behavioral health hospitals involved in the adoption of bhEHRs. We used purposeful sampling to maximize diversity. Transcripts were coded and analyzed for emergent domains. Exploratory data analysis was applied. RESULTS Content analyses revealed 4 barriers and 4 facilitators. The most important barriers to implementing bhEHRs were the low level of computer proficiency among nurses, the complexity of the system, alert fatigue, and resistance due to legacy systems. These barriers led to poor usability and acceptability and a distrust of the system. Among the major facilitators identified were well-executed training programs, improved productivity, better quality of care, and the good usability of the bhEHR system. CONCLUSIONS Healthcare professionals are keen to use bhEHRs, which may enhance their work productivity and interprofessional collaboration. Routine education for end users is the essential starting point to provide support for decision making and successful implementation of bhEHRs. When adopting bhEHRs, managers need to focus on common practices in behavioral health hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of behavioral healthcare into the system.

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Legal Regulation of Electronic Health Records: A Comparative Analysis of Europe and the US

eHealth: Legal, Ethical and Governance Challenges ◽

10.1007/978-3-642-22474-4_2 ◽

2012 ◽

pp. 25-56 ◽

Cited By ~ 2

Author(s):

Jos Dumortier ◽

Griet Verhenneman

Keyword(s):

Comparative Analysis ◽

Electronic Health Records ◽

Legal Regulation ◽

Health Records ◽

The Us ◽

Electronic Health

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Implementation of electronic health records in Polish outpatient health care clinics – starting point, progress, problems, and forecasts

Annals of Agricultural and Environmental Medicine ◽

10.5604/12321966.1203900 ◽

2016 ◽

Vol 23 (2) ◽

pp. 329-334 ◽

Cited By ~ 2

Author(s):

Aleksandra Czerw ◽

Adam Fronczak ◽

Karolina Witczak ◽

Grzegorz Juszczyk

Keyword(s):

Health Care ◽

Electronic Health Records ◽

Health Records ◽

Health Care Clinics ◽

Starting Point ◽

Electronic Health

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Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i2.1011 ◽

2018 ◽

Vol 25 (2) ◽

pp. 109-125 ◽

Cited By ~ 5

Author(s):

Mark Chun Moon ◽

Rebecca Hills ◽

George Demiris

Keyword(s):

United States ◽

Qualitative Study ◽

Electronic Health Records ◽

Hospital Setting ◽

The United States ◽

Theory Approach ◽

Health Records ◽

High Performing ◽

Advisory Groups ◽

Electronic Health

BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.ObjectiveTo understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.MethodsInformed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.ResultsThe study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.ConclusionsThe study describes overall experiences of optimising EHRs in select high performing healthcare organisations in the US. The findings highlight the importance of optimising the EHR after, and even before, go-live and dedicating resources exclusively for optimisation.

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Professional fission in medical routines: medical scribes and physicians in two US hospital departments

Journal of Professions and Organization ◽

10.1093/jpo/joaa023 ◽

2020 ◽

Author(s):

Ann L Bryan ◽

John C Lammers

Keyword(s):

Electronic Health Records ◽

Electronic Health Record ◽

Community Hospital ◽

Health Record ◽

Health Departments ◽

Health Records ◽

The Us ◽

Electronic Health ◽

Medical Scribes ◽

Digestive Health

Abstract In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.

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Quality and Certification of Electronic Health Records

Applied Clinical Informatics ◽

10.4338/aci-2010-02-r-0009 ◽

2010 ◽

Vol 01 (02) ◽

pp. 149-164 ◽

Cited By ~ 6

Author(s):

E. Ammenwerth ◽

A. Hoerbst

Keyword(s):

Information Systems ◽

Electronic Health Records ◽

Qualitative Content Analysis ◽

Real Life ◽

Health Records ◽

Selection Processes ◽

Quality Certification ◽

The Us ◽

Service Oriented ◽

Electronic Health

Summary Background: Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives: The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods: A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results: The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion: The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. Citation: Hoerbst A, Ammenwerth E. Quality and certification of electronic health records – An overview of current approaches from the US and Europe. Appl Clin Inf 2010; 1: 149–164 http://dx.doi.org/10.4338/ACI-2010-02-R-0009

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Barriers and facilitators to data quality of electronic health records used for clinical research in China: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-029314 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029314 ◽

Cited By ~ 2

Author(s):

Kaiwen Ni ◽

Hongling Chu ◽

Lin Zeng ◽

Nan Li ◽

Yiming Zhao

Keyword(s):

Qualitative Study ◽

Electronic Health Records ◽

Clinical Research ◽

Data Quality ◽

Healthcare Professionals ◽

Barriers And Facilitators ◽

Health Records ◽

Improve Data Quality ◽

Electronic Health

ObjectivesThere is an increasing trend in the use of electronic health records (EHRs) for clinical research. However, more knowledge is needed on how to assure and improve data quality. This study aimed to explore healthcare professionals’ experiences and perceptions of barriers and facilitators of data quality of EHR-based studies in the Chinese context.SettingFour tertiary hospitals in Beijing, China.ParticipantsNineteen healthcare professionals with experience in using EHR data for clinical research participated in the study.MethodsA qualitative study based on face-to-face semistructured interviews was conducted from March to July 2018. The interviews were audiorecorded and transcribed verbatim. Data analysis was performed using the inductive thematic analysis approach.ResultsThe main themes included factors related to healthcare systems, clinical documentation, EHR systems and researchers. The perceived barriers to data quality included heavy workload, staff rotations, lack of detailed information for specific research, variations in terminology, limited retrieval capabilities, large amounts of unstructured data, challenges with patient identification and matching, problems with data extraction and unfamiliar with data quality assessment. To improve data quality, suggestions from participants included: better staff training, providing monetary incentives, performing daily data verification, improving software functionality and coding structures as well as enhancing multidisciplinary cooperation.ConclusionsThese results provide a basis to begin to address current barriers and ultimately to improve validity and generalisability of research findings in China.

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