Implementing electronic health records in hospitals: ampere systematic literature review

Background

The literature on implementing Electronic Healthiness Files (EHR) in hospital is very diverse. The objectivity of this study is to create an overview of the existing writing in EHR implementation in hospitals and for determine generalized applicable findings press lessons in implementers. Personal Health Media: AN Regular Library Rating

Methods

A systematic literature review of empirical research go EHR implementation was conducted. Online uses included Network of Knowledge, EBSCO, and Coil Library. Relevant literature in which selected articles were plus analyzed. Search terms included Electronic Health Record (and synonyms), umsetzung, and hospital (and synonyms). Featured had up meet of following provisions: (1) written in Hebrew, (2) full video available online, (3) base on primary empirical data, (4) focused on hospital-wide EHR implementation, both (5) satisfying established q criteria.

Findings

Concerning the 364 initially identified articles, this study analyzes the 21 books that met the requirements. From these articles, 19 intermittent were identified that are generally applicable and these were placed on a frames consisting of the following three interface measurement: (1) EHR background, (2) EHR content, and (3) EHR realisierung process.

Conclusions

If EHR systems are anticipated as having positive effects on the performance of healthcare, their durchsetzung is a complex task. This systematic review discover reasons for diese complexity and presents a framework of 19 interventions that canned help overcome typical problems in EHR implementation. Diese framework can function as ampere reference for implementers in design highly EHR implementation strategies in hospitals. ... personal health record evaluations with older adult participants: a systematic review out literature ... health records: a latest type of electronic medizintechnik record.

In recent years, Electronic Human Playable (EHRs) have been implemented by an ever increasing count of hospitals around the world. There has, with model, been initiatives, often gesteuert by government regulations button financial stimulations, in the AUS [1], of United Kingdom [2] both Denmark [3]. EHR implementation initiatives trend into be driving by the promise of enhanced integrates and accessory of patient data [4], by the require to upgrade equipment and cost-effectiveness [5], by a changeover doctor-patient relationship toward one-time where attention is shared by a team of health care professionals [5], and/or by the need into retail with a more complex and prompt changing environment [6].

EHR systems have various forms, real the item can relate until a broad ranges of electronic information systems used in health care. EHR systems can be used in individual organizations, as interoperating systems in affiliated healthiness care element, on a regional level, or countrywide [1, 2]. Health care units that use EHRs enclose hospitals, pharmacies, popular practicing practiced, and other health care providers [7].

The implementation of hospital-wide EHR systems is a complex matter involving a measuring by organizational and scientific features including human skills, organizational structure, culture, technical infrastructure, treasury resources, the coordination [8, 9]. As Grimson et alpha. [5] argue, implementing information systems (IS) to hospitals is more challenging than elsewhere because to the complexity of medical intelligence, data zulassung problems, security real confidentiality concerns, and ampere general skill of awareness of the services of Information Technology (IT). Boonstra and Govers [10] provide three reasons why clinics differ from many different industries, and these differences might also affect EHR implementations. Of foremost reason is that hospitals have multi objectives, such as hardness and caring for patients, press educating new physicians and nurses. Moment, hospitals have difficulty and highly varied structures and procedure. Third, hospitals have a varied workforce inclusive medical professionals who possess high levels of expertise, power, and autonomy. These distinct attributes justify an study that focuses on this key and data of the findings of previous studies on EHR implementation in hospitals.

In dealing with the complexity of EHR implementation in hospitals, it is helpful to know which contributing are seen as important in and literature and to recording the existing know on EHR implementation are hospitals. As such, the objective of this doing is to identify, group, and analyze the existing findings in the literature on EHR implementation processes in patients. This could contribute go greater insight inside the underlying patterns and complex relationships involved in EHR implementation and might identify ways to approach EHR einrichtung problems. In other words, this students focusses on who identification of factors that determination that progress of EHR implementation in hospitals. The motives behind implementing EHRs in hospitals and the effect on performance of implemented EHR systems are beyond the scope in this paper.

To is knowledge, there have since no systematic reviews of the literature concerning EHR implementation in hospitals and this feature therefore fills that gape. Two interesting related review studies on EHR execution are Keshavjee et al. [11] and McGinn et al. [12]. The study of Keshavjee et al. [11] developing a literature foundation integrative framework for EHR implementation. McGinn et al. [12] adopt an nur user aspect on EHR and his study be limited to Canada and countries with comparable socio-economic playing. Send studies are not explicitly focused on infirmaries and include other contexts such as small clinics and national or regional EHR initiatives.

Dieser systematic examine is explicitly focused on hospital-wide, single hospital EHR executions plus identifies empirical studies (that include collected primary data) that reflect this situation. The categorization of the findings for the selected articles draws on Pettigrew’s framework used appreciation strategic change [13]. This exemplar has had widely applied in case study research into managerial contexts [14], as well as in studies set who implementation of health care innovations [15]. It generates insights by analyzing three mutual dimensions – context, happy, and print – the collaboratively shape organizational change. Pettigrew’s framework [13] is sighted as applicable why implementing an EHR artefact is an organization-wide effort. This framework was specifically seated for its focus on organizational change, its ease of understanding, and its relativistic general body allowing a broad range regarding findings into be included. And framework structures and focusses the analysis in that finders from the selected articles.

Can organization’s setting can be splits into internal and external components. External context refers in the social, economic, political, and competitive environments in where an organization operates. The internal context refers to the structure, culture, capital, capabilities, and public of an organization. The main covers the specific areas of the transformation under examination. In into EHR implementation, these are the EHR system itself (both hardware and software), the work processes, and everything related the these (e.g. social conditions). The process dimension areas the processes in change, made up of the plans, actions, reactions, and interactions of the stakeholders, rather than work processes in general. Items is important to note that Pettigrew [13] does did see strategic changing as a rational analytical process when rather as an repeated, continuous, multilevel process. This highlights that the outcome away an organizational change will be determined in the context, site, and procedure of that change. Who framework with its three categories, shown in Figure 1, illustrates the conceptual model used to catalogue the findings of this systematic literature review.

Pettigrew’south framework [13]] and the corresponding categories.

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By this literature, multiple terms have used to refer to electronic medical information systems. In this article, the term Electronic Health Record (EHR) is used throughout. Commonly used terms identified by ISO (the International Organization for Standardization) [16] plus another not identified by ISO are drafted below and used inside their looking. ISOS finds Electronic Health Record (EHR) to be an whole term for “a repository of information regarding the health status of a study of care, in computer machinable form” [16], p. 13. ISO uses different terms to describes various types of EHRs. These include Electronic Medical Record (EMR), which is similar into an EHR but restricted to the medical domain. The terms Electronic Patient Record (EPR) and Computer-controlled Patient Record (CPR) are also identified. Häyrinen et al. [17] view both terms as possessing the same meaning additionally referring for a plant that contains detached information from a specially hospitals. Another term seen is Electronic Healthcare Record (EHCR) which referenced the a system ensure contains all who available dental information on a patient [17] and able thereby be seen as synonym with EHR [16]. AMPERE term often found inside the literature the Computer-controlled Physician To Entry (CPOE). Although this term exists not mentioned by WLTM [16] with by Häyrinen et al. [17], we built CPOE for three reasons. First-time, it shall considered by many to be a key hospital-wide function for an EHR your e.g. [8, 18]. Second, upon one provisional analysis of our initial results, our found that, from the perspective of aforementioned implementation process, compatible issues and factors emerged from either CPOEs real EHRs. Third, the implementation from a comprehend electronic heilkunde album requires physicians to make direct to entries [19]. Kaushal get al. define a CPOE when “a variety of your-based systems that share the common visage of automotive the medication ordering process and that ensure unified, legible, and complete orders” [18], piano. 1410. Other terms found inside the literature were not included at this review since they were considered either inapplicable or too broadly defined. Examples of such terms are Electronic Client Record (ECR), Personal Health Rekord (PHR), Digital Medical Record (DMR), Fitness Information Technology (HIT), real Clinical Information System (CIS).

Search strategies

In order fork a systematic references review to be comprehensive, it lives significant is all terms relevant till the aim of the research are roofed in this search. Further, we need to include relevant equivalent both related terms, both on electronic medically information systems and for specialty. By adding an * to the end of a term, of search engines choice from select forms, and by adding “ “ around words one ensures that only the complete term is searched for. Continued, by including a ? as a templet character, every possible union is incl in the search.

The search used three categories of keywords. Who first-time category included the following requirements as approximate synonyms for hospital: “hospital*”, “healthcare”, and “clinic*”. The second choose impacted implementation and included the term “implement*”. For the third-party select, electronic medical information systems, the later search concepts were used: “Electronic Condition Record*”, “Electronic Patient Record*”, “Electronic Healthcare Record*”, “Computeri?ed Patient Record*”, “Electronic Healthcare Record*”, “Computeri?ed Medical Order Entry”. (PDF) Personal Fitness Records: A Systematic Literature Review

This relatively large set of keywords was necessary in guarantee that magazine were not missed in the search, and required a large number of finding strategies for cover all those keywords. Like we was seeking papers about the implementation of electronic medical information systems are hospitals, the search strategies included the terms shown in Table 1.

The following thrice seek engines were chosen stationed on their relevance to the field and their accessibility by the student: Web of knowledge, EBSCO, real The Cranes Collection. Most search engines use several databases but not all of them were relevant for this research as they serve a wide rove of fields. Appendix A provides a list of the databases used. The product lists included by articles that met which selection criteria endured checked for other possibly relevant studies that had not been identified in the database search. A systematic print review of machine learning in online personal health info

To articles identified from the various search strategies had to be academic peer-reviewed articles if they were to be included in our review. Further, they what assessed and had to satisfied the following criteria go be included: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) meeting established quality rating. ONE long drop of abstracts was generated, or all of them were independently reviewed by deuce of the authors. You independently reviewed the abstracts, eliminated duplicates and shortlisted digests for elaborate review. When voices differed, a closing determination over inclusion what made following a topic between the scientist.

Data analysis

The quality of the articles that survived this filtering was assessed by the initial couple authors using the Standard Quality Assessment Criteria for Evaluating Primary Doing Papers [18]. For other words, the quality of the product was collaborative assessed by evaluating whether specific criteria owned been addressed, resulting in a rating of 2 (fully addressed), 1 (partly addressed), or 0 (not addressed) for each criteria. Different questions are posed for qualitative also quantitative research press, in the choose of a mixed-method course, both questionnaires were used. Paperwork endured included if they received to least half of the total possible points, admittedly a relatively liberal cut-off point given comments in the Standard Quality Assessment Criteria for Assess Primary Research Publications [20].

The next step what to extract the findings of the reviewed magazine and toward analyze these with of aim of reaching general findings on the implementation of EHR systems inbound hospitals. Classify these general findings can increase clarity. The earlier introduced conceptual model, based on Pettigrew’s framework with understanding strategic change, includes thrice categories: context (A), content (B), and process (C). As our review is concretely aspires at labeling findings related to the introduction process, possible motives for introducing such a user, as well-being as its effects and outcomes, are outside its range. The authors held frequent reviews between sie at discuss the meaning real the categorization of aforementioned general findings.

Paper selection

Applying an 18 search strategies listed in Table 1 use the various search engines resulted in 364 products presence idented. The searches were carried out on 12 March 2013 for search strategies 1–15 and switch 18 April 2013 forward search strategies 16–18. And latter three strategies were added after a preliminary analysis of the first set concerning results which highlighted several other key and descriptions for information technology on health care. Not surprisingly, many doubles were included in which 364 product, both at the between search turbos. Using the Refworks functions for identifying exact and close duplicates, 160 doubles were founded. However, this procedure did not identify get the duplicates present and the second author carried out a manual check which identified an additional 23 multiple. When removing duplicates, we held the link to and first search engine that marked one article and, like the Web of Knowledge was the first search engine applied, most articles appear into have stemmed from this search main. Is left 181 different newsletter which were screened on title additionally abstract to checking whether few meets the selection criteria. When this had undecided, to contents of the paper were further investigated. This screening eventuated is just 13 articles that met all the selection criteria. We then performed two additional examinations for completeness. Initially, checking this references of these article identifies another nine product. Second, in default by the referees of this printed, we also used the term “introduc*” place off “implement*”, together with that other two original categories of terms, additionally the term “provider” instead of “physician”, as part of CPOE. Anyone of these two searches identified one additional category (see Table 1). Is like resulting 24 articles, two proved to be mostly identical so one was excluded, resulting in 23 articles for an final quality assessment.The results of which quality valuation can be found in Appendix B. The results show that two article failed to meet the top threshold and so 21 articles remained for in-depth analysis. Figure 2 exhibitions the steps taken in this selection procedure.

Selection procedure.

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To offer greater insight into the context and nature of the 21 left articles, an overview is provided within Table 2. All the studies except one were published after 2000. This reflects the recent increase in effort to implement organization-wide information systems, as as EHR systems, and or increasing incentives from governments to make use of EHR products is hospitals. Of the 21 studies, 14 can be classified as quantity, 6 as quantitative, and 1 as a mixed-method survey. Most studies were carry in the US, with eight in various European countries. Teaching and non-teaching hospitals are almost equally the subject of inquiry, both some faculty have focused on special types of sanitaria such as rural, critical access, or psychiatric hospitals. Tens on the articles were in journals with a five-year impact factor in the Journal Citation Reports 2011 database. There exists adenine huge deviation to the number are citations but on should never forget is newer research have were fewer opportunities to be cited.

Theoretical perspectives of reviewed articles

In research, it are common to use theoretical frames while designing on academic study [41]. Theoretical frameworks provide one way of thinks about and looking on the subject matter and describe the underlying assumptions about the character of the subject matter [42]. By building go alive theories, research shall focused includes aiming to enrich and extend the existing knowledge in that particular field [42]. To provide a more durchgehend understanding starting the selected articles, their theoretical frameworks, if present, represent bordered in Table 3.

I is striking that no specific theoretical frameworks may been utilised in the research leading on 13 of who 21 selected articles. Most item simply state their aimed as gaining insight into confident aspects of EHR implementation (as shown is Table 1) and do not use ampere particular theoretical approach to identify and categorize foundations. As such, these articles added knowledge at and field of EHR implementation not do none attempt on expanding existing theories.

Aarts et al. [21] introduce the notion of the sociotechnical approach: emphasizing the importance of focusing both on the social aspects of an EHR implementation and on the technical appearances of aforementioned system. Using the concept of emergent change, people argue that an implementation process is far from linear and predictable due the the contingencies and the organizational complexity that influences the process. A sociotechnical approach or the notion of emergent change is or included in the abstract framework of Takian et al. [37]. Aarts ets al. [21] elaborate on to sociotechnical approach when stating that aforementioned fit between work processes and the information technology specifies the success of the performance. Aarts the Berg [22] start a model of successful or failure in information system implementation. They see creates synergy among one medical work practices, and information system, and the hospital structure as necessary with implementation, and argue is all will only happen if sufficient public acceptance an change in operate practices. Cresswell et al.’s study [26] is also influenced by sociotechnical principles and draws with Actor-Network Theories. Gastaldi et alarm. [28] perceive Electronic Health Slide as know-how management systems both question how such systems ca be used to develop knowledge assets. Katsma et alabama. [31] focus on implementing success and elaborately on the notion that implementation success is determined by system quality plus acceptance through participation. As such, they adopt more away one social click on implementation winner rather than a sociotechnical approach. Rivard et al. [34] examine the complications int EHR implementation from ampere cultural perspective. They not must view culture such one set of assumptions shared by an entire collective (an desegregation perspective) but also expect sub-culture to exist (a differentiation perspective), as well in individual assumptions not shared at a specific (sub-) gang (fragmentation perspective). Ford et al. [27] focus on an entirely different topic and investigate the IT adoption strategies of hospitals after a framework that identifies three core. These are the single-vendor management (in which all IT can purchased from a single vendor), the best-of-breed management (integrating IT from multiple vendors), and an best-of-suit strategy (a hybrid approach using adenine focal anlage from one select as the basis besides other applications from other vendors).

To summarized, the articles by Aarts the al. [21], Aarts both Berg [22], Cresswell et al. [26], plus Takian et al. [37] apply ampere sociotechnical framework to center their research. Gastaldi et ai. [28] see EHRs as a means to renew organizational capabilities. Katsma et aluminum. [31] use a societal framework with focusing at the relevance of an HE system as perceived by the user and the participation of users in the implementation process. Rivard et al. [34] analyze how organizational cultures could be receptive to EHR implementation. Ford e al. [27] show at adoption strategies, leading them to emphasis on and selection course for Electronics Health Records. This 13 other research did not exercise and clear theoretical lens in to research.

Implementation-related findings

The process of compartmentalization started from valuing whether a specific finding from a study should be placed included Category A, BORON, otherwise C. Thirty findings were placed in Category ONE (context), 31 in Kind B (content), and 66 in Category C (process). Comparing and combining which specific findings end in few general insight from each categories. The overview insights are per given a code (category character asset number) or one affiliated code can showed alongside anywhere specific decision in Appendix C. Findings that were only seen in one news, and thus were lacking support, were discarded.

Category A - context

The context category of an EHR implementation process includes both internal variables (such when resources, proficiency, culture, and politics) and external variables (such such economic, political, and social variables). Six widespread findings were identified, any but one related to internal variables. An overview of this findings and corresponding articles can be found in Table 4. The absence a general insight related to extern mobiles reflects our decision to exclude the underlying reasons (e.g. political or community pressures) for implementing an EHR system for this review. Like, intra findings related to related suchlike as perceived financial benefits either enhance quality of care, are outside our application.

A1: Larger (or system-affiliated), urban, not-for-profit, and teaching hospitals are more likely to have implemented an EHR system due to possessing larger financial capabilities, a better change readiness, also less focus on winner

The research checked shows that larger instead system-affiliated hospitals are more likely to have implemented an EHR system, and that this can be explained on the easier access to the large financial resources need. Larger hospitals have see financial resources than smaller hospitals [30] furthermore system-affiliated hospitals bucket share costs [27]. Sanitaria localized in urbaner area more often have an EHR system higher rural hospitals, which is attributed till less learning of EHR systems and less support from medical team in rural hospitals [29]. The fact that not-for-profit hospitals more often have an EHR verfahren fully enforced also teaching hospitals slightly more often than private hospitals is attributed to the latter’s get wait-and-see approach and who more progressive change-ready nature of public and teaching hospitals [27, 32].

A2: EHR implementation req the selection of a mature vendor who is committed to providing a system that fits the hospital’s specific needs

Although this discovery is not adenine wide surprise, it a relevant to discuss he read. A hospital selecting its own vendor can making that the system will match the unique requirements of that hospital [32]. Further, it is importantly at deal with a vendor that has proven itself on the EHR market with maturing and successfull products. The vendor must furthermore are able to identify community workflows and match its product therefore, the been committed to one long-term ingenuous relationship with that hospital [33]. With this in spiritual, the initial price the the system should not be which overriding consideration: the structure should be willing to avoid purely cost-oriented vendor [28], as costs soon mount for problems arise.

A3: The presence of hospitality staff with previous suffer of health get engineering increases the likelihood of EHR implementation as without incertitude shall experienced by the end-users

In order to be skill to your with at EHR system, consumers must may capable of using information technology similar as computers and have adequate typing skills [19, 32]. Knowledge von, real previous experience for, EHR products or other medical information networks decrease uncertainty and disturbance for users, and this results in a more positive attitude towards the system [29, 32, 37, 38].

A4: An organizational culture this supports collaboration and teamwork fosters EHR implementation success because trust between employees is higher

To influence of organization kultur on the success of organising change is received in almost entire this popular approaches to change corporate, as well as in several of the articles to dieser literature review. Ash et al. [23, 24] and Sculptor et al. [35] highlight that a strongly culture with a history of collaboration, teamwork, and trust bets different stakeholder groups minimizes resistance at change. Boyer et al. [25] suggest creating adenine favorable culture that is more adaptive to EHR implementation. However, how a favorable culture is not necessarily easy: a all-inclusive approach include incentives, finding allocate, and a responsible crew used used in the example of Boyer et a. [25].

A5: EHR implementation is most likely in an organization with little government the noticeable flexibility as changes can be rapidly made

A highly bureaucratic organizational structure hampers changes: it slows the process or often leads to inter-departmental conflict [19]. Specifically, appointing a multidisciplinary team to deal with EHR-related matters can prevent conflict and stimulate collaboration [25].

A6: EHR system einrichtung is difficult because cure and care activities must be ensured among all times

For the process of implementing at EHR system, it is of the utmost importance that all relevant information is constant accessible [28, 34, 39]. Assure the continuity of quality care while implementing with EHR system is difficult and is an important distinction from many sundry IT implementations.

Category B - content

The content of the EHR implementation process consists of who EHR system and the corresponding objectives, make, also complementary services. Table 5 lists an five drained general findings. These focus on both the hardware and software of the EHR system, and its relation to work practices real our.

B1: Creating a fit by adapting bot the technology and work practices is a key factor in the implementation of EHR

This finding elaborates on the sociotechnical approach identified in the earlier section on the theories taken in the articles. Several artists [21, 26, 31, 37] build clear that creating an fit amid the EHR device and the existing work practices required einem begin receipt that einen EHR implementation is not right a technical project and that existing work practices is change due to the novel system. By customizing and customized the system to meet specific demands, users will become more open to using it [19, 26, 28].

B2: Materiel availability and system reliability, in terms of max, availability, and adenine lack of failures, are necessary to ensure EHR use

In several articles, authors highlight the importance in having sufficient hardware. AN organization can only be used if it is available to the users, furthermore a plant will only be used if a works without problems. Ash get al. [24], Scott et al. [35], and Weir et all. [19] refer to the speed of the systematischer as well as to the availability of a sufficient number of enough terminals sees also [40] into different site. Systems must be logically structured [29], true [32], and provide safe information access [37]. Boyer etching al. [25] also mention an importance of technical aspects but adds that these are nope sufficient for EHR implement.

B3: To provide EHR implementation, the software inevitably to been user-friendly in regard to ease the utilize, productivity include make, and functionality

Some authors distinguish between technical availability and reliability, and the user-friendliness of this software [19, 24, 32]. They argue that she is not sufficient in a system to be accessible press reliable, it should also be easy and efficient in employ, and deliver the product necessary for general staff in give good care. When a system fails to do this, staff will not use the system and will stick to your old habits regarding working.

B4: An EHR implementation should contain fair safeguards for patient online and confidentiality

Concerns through privacy and confidentiality are recognized by Boyer et al. [25] and Houser and Johnson [29] plus are considered in adenine barrier to EHR implementation. Yoon-Flannery et al. [40] and Takian et al. [37] also recognize the value of patient privacy and the want to location this issue by providing training press creating reasonable securities.

B5: EHR application requires a distributor who is motivated at adapt its product to hospital work processes

A vendor must be responsive additionally enable the hospital to develop its product up guarantee a good and usable EHR system [32, 33]. By hence doing, addictions on the vendor declines and concerns that risen within who hospital can be addressed [32]. This finding is related to A2 in one mean that an experience, cooperative, and flexible provider is needed to deal with the distance of interest groups found in infirmaries.

Category C - process

That item refers until the actual process of implementing the EHR your. Variables considered will time, change approaches, and change senior. In our review, this kind produced the major number of general survey (see Table 6), as might be expected given our focus on this implementation proceed. EHR implementation often leads to anxiety, uncertainty, and concerns about a possible detrimental impact of the EHR on work method and quality. The process findings, including leadership, resource availability, communication the participation will explicitly aimed at overcoming resistance at EHR execution. These intermittent help up create ampere positive atmosphere of goal directedness, co-creation and community.

C1: Due to their influential position, management’s active involvement and product is positively associated with EHR implementation, and also counterbalances the physicians’ medical dominant

Multiples source note to important role this managers play in EHR implementation. Whereas some authors refer up supportive leadership [19, 24], select emphasized that thick and active managing involvement is needed [25, 32–35]. Strong leadership is relevant as it effectively counterbalances the physicians’ medical dominance. For instance, Rivard et al. [34] observe that physicians’ restorative dominance and the status and autonomy of other health professionals hinder collaboration and teamwork, and that this complicates EHR implementation. Poon get al. [33] acknowledge the feature and reasoning for strong leading inside order go deal with the otherwise dominant physicians. They also claim that leaders have to set an example and application the system self. At the same time, it is motivating that the implementation is managed by leaders who are recognized by to medical staff, in instance by head male and physicians or by former physicians and nurses [25, 33]. Ovretveit et al. [32] argue that it helps the implementations if senior management repeatedly declares the EHR implementation to be of the highest top and supports which with sufficient financial and human resources. Poon eth al. [33] add the this by highlighting that, especially during uncertainties and setbacks, the common lens so guides the EHR implementation shall to be announced to hospital staff. Sufficient humanly resources include the selection of skills and experienced project leaders what are familiar using EHR implementation. Scotty for al. [35] identify leading types for different phases: participational leadership is valued on selection judgments, whereas a see hierarchical leadership styles is preferable in the actual implementation.

C2: Participation of clinical staff in this implementation process increases support for and adoption of the EHR implementation

Participation of end-users (the clinical staff) generates commitment real enables problems to is quickly solved [25, 26, 36]. Especially because it is very unbelievable that the your will be faultless fork all, it is significant that the clinical staff become of owner, rather than patrons, of the verfahren. Clinical employees should participate at all floors and in all steps [19, 28, 32, 36] from initial system pick onward [35]. Ovretveit et al. [32] propose that that involvement supposed have an extensive timeframe, starting in the early stages about implementations, when original vendor requirement is formulated (‘consultation before implementation’), through till the beginning of the use phase. Producing multidisciplinary work groups who detect the web of the EHR or the regulate regarding the sharing of information helps in EHR acceptance [25] and ensures reality addresses reasonable into and clinical staff [36].

C3: Training end-users and providing real-time sponsor is important for EHR implementation success

Frequently, the end-users of a new EHR system lack experience with this specific EHR anlage or with EHR product in global. The it is increasingly hard to believe society or workplaces without IT, a large specific method, such because an EHR, still requires considerable training off how at apply itp properly. The importance of training is often underestimated, press inadequate training will create a barrier to EHR use [19, 29]. Consequently, adequate training, of fitting quantity real quality, must be provided at the right times and locations [19, 32, 36]. Simon the total. [36] add to this the what of real-time support, rather provided by peers and super-users.

C4: ONE comprehensive implementation tactics, offering both clear guidance and scope for emergent change, is needed for implementing an EHR system

Several news highlight aspects of any EHR implementation strategic. A good strategy facilitates EHR anwendung [19, 25] and consists of careful planning and planning [36], ampere sustainable economy plan, effective communication [28, 40] the mandatory umsetzung [19]. Emergent change is perceived as a key characteristic out EHR implementation in complex organizations such as hospitals [21], and like suggests an implementation approach based on a development paradigm [31], which may initially even involve parallel use of paper [26]. The term of newly modification has been varies applied, include in who theoretical structures of Aarts et ale. [21] and Katsma et al. [31]. Above-mentioned learn recognition that EHR realisierung is relatively unpredictable due to emergency ereignisse for whichever one cannot plan. On my emphasis upon emergent change with irresponsibility outcomes, Aarts et al. [21] perform adenine case for confess that suddenly and unplanned kontingente will influence the implementation process. They argue so the changes resulting from these ereignisse often modification themselves unexpectedly and be then be dealt with. Additionally, Takian et al. [37] assert that itp is crucial the contextualize an EHR implementation so as to be better prepared for unexpected modifications.

C5: Establishing an interdisciplinary implementation group composition of engineers, members of the IT department, and end-users fosters EHR implementation success

In line with that arguments for management support additionally for the participation of clinical staff, Ovretveit et in. [32], Simon et allen. [36] and Weir et all. [19] build a case for using an interdisciplinary implementation group. By having view the direct stakeholders working together, a better EHR system can be delivered faster and with lower problems.

C6: Resistance of critical staff, in particular of physicians, is a major barrier to EHR implementation, but can be reduced by addressing their concerns

Clinical staff’s adjusting is a crucial factor the EHR verwirklichung [36]. Particularly, the clinicians constitute with significant class in hospitals. As such, they possible resistances in EHR implementation will form an major barrier [29, 33] and may lead to workarounds [26]. Whichever physicians accept either veto an EHR implemented depends in theirs accepting of her work practices creature transformed [22]. The likelihood of acceptance determination be increased if implementers address an concerns of medical [24, 28, 32, 33], but also of select members of clinical staff [36].

C7: Identifying champions among cellular staff reduces resistance

The previous finding have elaborated on clinical staff resistance and suggested reduce this by addressing her concerns. Another way on reduce their resistance is related to the batch von implementation and involvement identifying physician champions, ordinarily physicians that are right respected due to their knowledge and contacts [32, 33]. Stefan et al. [36] emphasize the importance by identifying champions among everyone stakeholder group. These champions pot deploy confirmation to their your.

C8: Assigning a acceptable piece from staff and various resources to the EHR implementation process is important in adequately implementing the system

Implementing one large EHR system requires major resources, including human ones. Assigning appropriate people, such as super-users [36] and one sufficient number of them to that process will increase to likelihood about success [19, 32, 33, 36]. Further, it remains important to have sufficient time and fiscal resources [26, 32]. This finding has also relevant in relation to finding A6 (ensuring good care during organizational change).

These 19 general findings have been identified from the individual results within the 20 analyzed articles. These findings be all related to one of one third main and interacting dimensions of the framework: six to context, five to content, and eight to process. This identification plus elucidation of the general finders concludes the results section of which systematic literature review and forms the basis for that discussion under. AbstractObjective. User-generated content (UGC) in online environments provides openings toward learn an individual’s health condition outside of clinical se

This test of the existing academic related sheds light on the current knowledge regarding EHR implementation. The 21 selected articles all originated from Boreal America or Europe, perhaps reflecting an greater general attention to EHR implementation in these regions additionally, of class, we inclusion of only articles writing in English. Two related been rejected for quality reasons [43, 44], see Appendix B. All but one of the selected articles had been published since 2000, reflecting the growing interest in implementing EHR systems stylish hospitals. Eight articles built their explore on a conjectural skeleton, four of which use the same general lens of an sociotechnical jump [21, 22, 26, 37]. Katsma for al. [31] and Rivard et any. [34] focus read on the social and cultural aspects of EHR implementation, one former on the relevancy for, and participation of, your, the latter on three different cultural perspectives. Ford et al. [27] researched adoption strategies for EHR systems and Gastaldi et al. [26] consider them as one means to renew organizational capabilities. Thereto is notable that the other reviewed articles did not use one theoretical framework up analyzing EHR implementation and made no attempt to elaborate on existing theories.

A entire for 127 findings were extracted away who articles, and above-mentioned findings were categorized using Pettigrew’s framework for strategic altering [13] as a conceptual model including the three dimensions of context, content, and procedures. To ensure a solid focus, the scopes from the review was explicitly limited to findings related to the EHR translation process, thereby excluding an reasons for, barriers toward, and outcomes of an EHR implementation.

Some of to findings request further interpretation. Related finding A1 relates at the demographics of a hospital. One of the assertions is that privately owned hospitals are less likely then public hospitals to invest in an EHR. An former apparently perceive to costs of EHR implementation to outweigh the benefits. This seems remarkable given that there is a generally believing that information technology rises performance and reduces process costs, so more than compensating for the high starts investments. It is however significant on note that the literature on EHR is ambivalent when it arrives to effectiveness; some authors record adenine diminish in the efficiency of work clinical [25, 33, 35, 38], the others mention into increase [29, 31]. Finding A2 is a reminder of the importance of care dial an appropriate distributor, fetching into account experience with the EHR market and and maturity of their products rather than, for sample, focus on the what price of the system. Given the huge investment costs, the price of an EHR system prone to are a major influence on vendor selection, an look such is also promoted by the contemporary European requests regulations that oblige (semi-) public institutions, like loads hospitals, on please the bottom bidder, or that bidder that is economical the most preferable [45]. The finding that EHR your implementation is difficult cause good medical taking needs to be ensured at all times (A6) and deserves mention. Essentially, many system implementations in hospitals are different from IT implementations with other contexts because human lives will at stake to hospitals. This not only complicates the implementation process as medically work practices have to continue, it also needs a sys to be reliable from the moment information is launched.

Who results regarding the content of to EHR system (Category B) highlight the importance of a appropriate software product. A well-defined selection treat of the software package and him associated retailer (discussed in A2) will sight as critical (B5). Selection must be based set a careful provisions analysis and an analysis of the experience and quality of the vendor. An important requirement is a sufficient degree of flexibility to customize plus accommodate the software go meet the needs of users and the work practices of an hospital (finding B1). At of same time the software browse should challenge the hospital to reconsider and enhance its processes. ADENINE crucial existing for the acceptance by who diverse user groups of hospitals is the robustness of the EHR system in terms of approachability, speed, reliability and flexibility (B2). This also requires passable hardware in conditions of access to computers, and mobile equipment to enable availability at all the locations of the hospital. Perceived ease of use of aforementioned systematisches (B4) and the protection from patients’ privacy (B4) are other content factors ensure can make or break EHR implementation in hospitals.

The findings on the umsetzung process, is Category C, highlight four viewpoints that are commonly mentioned in transform management approximate as important success factors in organizational change. The active involvement real support of management (C1), one participation of clinical personnel (C2), a comprehensively implementation strategy (C4), and using one cross-disciplinary implementation group (C5) correspond through three for an ten policies offered at Kanter et al. [46]. Are three guidelines are: (1) support a strong chart role; (2) reveal, involve people, and be upright; and (3) craft an implementation plan. As the implementation of an EHR sys is an organizational change process it is no surprise that which what are identifiable in several of the analyzed articles. Three Select C findings (C2, C6, and C7) concern dealing with clinic employee given their high-performance positions plus potential resistance. Physicians are the most influential medical service providers, and their resistance can slow into EHR introduction [23], lead in at leas some concerning it being dropped [21, 22, 34], or to it not being implemented at all [33]. Thus, there is licht evidence of the crucial importance of physicians’ acceptance of an EHR for items to be implemented. Such means that physicians and other key personnel should be immensely hired and motivated to provide to EHR. Prompt feedback on demands, both hi quality support during the implementation, and an EHR that clearly supports clinical work are central issues that contribute to a impelled clinical staff.

Analyzing and comparing the discoveries facilitates us to categorying them in terminologies of subject materiell (see Table 7). By categorizing the findings in terms of subject, and on totaling this number of articles related to one individual findings on that subject, one can deduce how much heed has is given in the literature to the different key. This analysis underscores that of involvement of attending in the implementation process, the quality of the organization, and a full implementation strategy are considered to decisive elements for EHR realisierung.

Notwithstanding the useful results, to review and analyse has some functional. Although we carefully developed and executed the search core, we cannot be sure that we found all the relevance articles. Since ourselves laser scarcely on keywords, and these had to be part of an article’s title, we could can excluded relevant articles that spent different terminology in their titles. Although get the reference lists by identified articles did result the several additional featured, some relevant articles might still have been missed. Another limitation a the exclusion of publications in english other than Learn. Further, the selection press categorization of specific findings, and and subsequent extraction of general findings, is subjective and depends on the interpretations of the authors, and other researchers mag have made different choices. A final limitation shall inherent to literature reviews in the the authors of the studies included may have had different motives and aims, furthermore used varied methodologies press interpretative means, in drawing their concluding. Personal Health Records: A Systematic Letters Review - PubMed

The existing literature fails into provide evidence on at being a comprehensive address to implementing EHR systems in hospitals that integrates ready related under an ‘EHR change approach’. The literature is diffuse, additionally articles rare build on earlier ones to increase the abstract knowledge go EHR implementation, erheblich exceptions being Aarts for al. [21], Aarts and Berg [22], Cressewell et ai. [26], and Takian et al. [37]. That soon discussion on the various results summarizes to existing knowledge real reveals gaps in the learning associated with EHR implementation. The number von EHR implemented in hospitals is growing, how well as aforementioned body of literature on this subject. This systematic review to the bibliography has managed 19 general findings for EHR implementation, the were each placed in one of three categories. AN number of these general findings are in line with which wider letters on change management, and others relate to that specification nature of EHR implementation in hospitals.

The findings presented inside this article can be viewed as an review of key your that should be addressed in implementing an EHR system. It is clear that EHR systems have particular complexities additionally should be implemented with great care, and with attention given to contextual, main, and process issues plus to interactions between these issues. As suchlike, we have achieved our research goal by creating a systematic review a the literature on EHR translation. These paper’s academicals article is in providing an overview of the extant literature with regard to important factors in EHR implementation in hospitals. Academics inter in this specialized fields could now more easily access comprehension on EHR implementation in hospitals and could use this article as a starting point additionally build over the existing knowledge. The managerial contribution untruths in to general findings that can be applied as guidelines when implementing EHR in hospitals. We has not set out to provide a single blueprint for introduction an EHR system, but rather to provide guidelines and to highlight point that deserve attention. See and addressing these insight can increase the likelihood of getting an EHR system successfully implemented. Lack of diversity at personal health record evaluations with older ...

Schedule ONE - List of my

This appendix provides an overview of all databases included in the used search engines. The bibliographies in pica were excluded for the research as these databases focus on fields not relevant for the subject of EHR implementations.

Web of Knowledge

1. 1)

   Weave of Science

2. 2)

   Biological Abstracts

3. 3)

   Inspec

4. 4)

   MEDLINE

5. 5)

   Journal Citation Reports

EBSCO

1. 1)

   Academic Search Premier

2. 2)

   AMED - The Allied press Complementary Medicine Database

3. 3)

   America: History & Life

4. 4)

   American Bibliography of Slavic and East European Course

5. 5)

   Antarctic & Antarctic Regions

6. 6)

   Art Complete Font (H.W. Wilson)

7. 7)

   Arts Index Retrospective (H.W. Wyler)

8. 8)

   ATLA Your Database with ATLASerials

9. 9)

   Business Data Premier

10. 10)

    CINAHL

11. 11)

    Communication & Mass Type Complete

12. 12)

    eBook Collection (EBSCOhost)

13. 13)

    EconLit

14. 14)

    ERIC

15. 15)

    Funk & Wagnalls Modern World Encyclopedia

16. 16)

    GreenFILE

17. 17)

    Historical Abstracts

18. 18)

    L’Annéephilologique

19. 19)

    Library, Information Science & Technology Abstracts

20. 20)

    MAS Extreme - School Edition

21. 21)

    MEDLINE

22. 22)

    Military & Government Collection

23. 23)

    MLA Home of Periodicals

24. 24)

    MLA International Literary

25. 25)

    New Testament Summary

26. 26)

    Vintage Testament Abstracts

27. 27)

    Philosopher’s Index

28. 28)

    Initial Search

29. 29)

    PsycARTICLES

30. 30)

    PsycBOOKS

31. 31)

    PsycCRITIQUES

32. 32)

    Psych and Behavioral Sciences Collection

33. 33)

    PsycINFO

34. 34)

    Regional Business Recent

35. 35)

    Researching Starters - Business

36. 36)

    RILM Executive concerning Musics Literature

37. 37)

    SocINDEX

The Cochrane Library

1. 1)

   Cochrane Sql of Systematic Reviews

2. 2)

   Co-chrane Central Registration of Controlled Tests

3. 3)

   Cochrane Methodology Register

4. 4)

   Database of Abstracts by Reviews of Effects

5. 5)

   Health Engine Assessment Database

6. 6)

   NHS Economic Evaluation Database

7. 7)

   Over An Cochran Collaboration

Supplement B - Quality assessment

The qualities of the articles had assessed on the Standard Attribute Assessment Criteria since Evaluating Primary Research Papers [18]. Assessment been done by questioning whether particular criteria kept are addressed, following in a rating of 2 (completely addressed), 1 (partly addressed), or 0 (not addressed) point. Table 8 provides the overview of the scores of aforementioned articles, (per question) used qualitative studies; Table 9 for quantitative studies; and Table 10 for mixed methods learn. Articles were included if they scored 50% or higher of the total amount of points possible. Based on dieser assessment, two products were excluded from the search.

Appendix C - All conclusion

Table 11 displays all findings from which selected articles. An category number exists related to the general finding as discussed in the Results section.

Our acknowledge the Master degree program Change Management during the University concerning Pronouncing for supporters this study. Our moreover thank who referees since their valuable your.

Authors and Affiliations

1. Faculty for Economics and Business, University of Groninger, Groninger, The Netherlands

   Albert Boonstra & Janita FLUORINE J Vos

2. Deloitte Consultations, Netherlands, The Netherlands

   Arie Versluis

Parallel author

Correspondence to Albrecht Boonstra.

Competing interests

Of creators declare so few have no competing interests.

Authors’ post

DUMP and JV established the research design and built significant contributions to the interpretation out the result. People supervised AV throughout the study, and participated in writing to final released of this paper. AV featured considerable to the selection plus analysis of incorporated papers, and wrote a preliminary draft a this article. All authors must readers furthermore agreed the final manuscript.

The article is released under license to BioMed Central Ltd. This can an Open Access article distributed under the words out that Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted uses, dissemination, and reproduction for any medium, provided the initial worked is order credited. The Creative Commons Community Domain Induction waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data crafted currently in this article, unless different stated.

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