Challenges and Facilitators to Adoption of a Point-of-Care Electronic Health Record in Home Care

Electronic health records (EHRs), intended to improve the clinical process, are understudied in home care. The researchers assessed clinician satisfaction, informed by workflow and patient outcomes, to identify EHR adoption challenges. The mixed methods study setting was a Philadelphia agency with 137 clinicians. Adoption challenges included: (a) hardware problems coupled with lack of field support; (b) inadequate training; and (c) mismatch of EHR usability/functionality and workflow resulting in decreased efficiency. Adoption facilitators were support for team communication and improved clinical data timeliness. Opportunities for improved adoption included sharing with front-line clinicians EHR data related to patient care and health outcomes.

[1]  Dean F. Sittig,et al.  Work-sampling: a statistical approach to evaluation of the effect of computers on work patterns in the healthcare industry. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[2]  Kathy Smith,et al.  Evaluating the Impact of Computerized Clinical Documentation , 2005, Computers, informatics, nursing : CIN.

[3]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[4]  H. Lehmann,et al.  A New Instrument for Measuring Clinician Satisfaction With Electronic Health Records , 2011, Computers, informatics, nursing : CIN.

[5]  Shobha Phansalkar,et al.  Patient Safety and Health Information Technology: Role of the Electronic Health Record , 2008 .

[6]  Suzanne Bakken,et al.  Informatics for Patient Safety: A Nursing Research Perspective , 2006, Annual Review of Nursing Research.

[7]  N. Burns,et al.  The practice of nursing research , 2013 .

[8]  R E Reynolds,et al.  Case study: a data warehouse for an academic medical center. , 2001, Journal of healthcare information management : JHIM.

[9]  George Hripcsak,et al.  Inter-patient distance metrics using SNOMED CT defining relationships , 2006, J. Biomed. Informatics.

[10]  J. Feinglass,et al.  The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. , 2004, Archives of internal medicine.

[11]  S. Kossman,et al.  Perceptions of impact of electronic health records on nurses' work. , 2006, Studies in health technology and informatics.

[12]  Richard J. Whiddett,et al.  User acceptance of inter-organizational electronic medical records , 2001 .

[13]  Ting-Ting Lee,et al.  Two-stage evaluation of the impact of a nursing information system in Taiwan , 2008, Int. J. Medical Informatics.

[14]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[15]  Michael E. Miller,et al.  Electronic Health Records , 2014, Annals of Internal Medicine.

[16]  E. M. Campbell,et al.  The Impact of Health Information Technology on Work Process and Patient Care in Labor and Delivery , 2008 .

[17]  M Berg,et al.  The Search for Synergy: Interrelating Medical Work and Patient Care Information Systems , 2003, Methods of Information in Medicine.

[18]  Subhasish Dasgupta,et al.  MEASUREMENT OF USER SATISFACTION WITH WEB-BASED INFORMATION SYSTEMS: AN EMPIRICAL STUDY , 2002 .

[19]  Patricia Gauthier,et al.  Integrating feedback from a clinical data warehouse into practice organisation , 2006, Int. J. Medical Informatics.

[20]  Sara Rosenbaum,et al.  Electronic health records' limited successes suggest more targeted uses. , 2010, Health affairs.

[21]  T. M. Anderson,et al.  Barcode Medication Administration: Lessons Learned From an Intensive Care Unit Implementation , 2005 .

[22]  Craig E. Kuziemsky,et al.  A review on systematic reviews of health information system studies , 2010, J. Am. Medical Informatics Assoc..

[23]  Dean F. Sittig,et al.  Work-Sampling: A Statistical Approach to Evaluation of the Effect of Computers on Work Patterns in Healthcare , 1993, Methods of Information in Medicine.

[24]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[25]  Angela A Richard,et al.  Improving Patient Outcomes of Home Health Care: Findings from Two Demonstration Trials of Outcome‐Based Quality Improvement , 2002, Journal of the American Geriatrics Society.

[26]  Jinjiao Wang Mental Health Disorders of Home Care Elders in the United States: A Secondary Analysis of the Outcome and Assessment Information Set (OASIS) , 2015 .

[27]  P. Gorman,et al.  Perceptions of physician order entry: results of a cross-site qualitative study. , 2003, Methods of information in medicine.

[28]  E A Balas,et al.  Improving preventive care by prompting physicians. , 2000, Archives of internal medicine.

[29]  C. Kovner,et al.  Bedside terminals and quality of nursing documentation. , 1993, Computers in nursing.

[30]  Thomas H. Payne,et al.  A cross-site qualitative study of physician order entry. , 2003, Journal of the American Medical Informatics Association : JAMIA.

[31]  Robert J G Chalmers,et al.  Health care terminology for the electronic era. , 2006, Mayo Clinic proceedings.

[32]  Philip Darbyshire,et al.  'Rage against the machine?': nurses' and midwives' experiences of using Computerized Patient Information Systems for clinical information. , 2004, Journal of clinical nursing.

[33]  Qingxia Chen,et al.  An Electronic Medical Record in Primary Care: Impact on Satisfaction, Work Efficiency and Clinic Processes , 2006, AMIA.

[34]  H. Lehmann,et al.  Community-Based, Interdisciplinary Geriatric Care Team Satisfaction With an Electronic Health Record: A Multimethod Study , 2012, Computers, informatics, nursing : CIN.

[35]  Robert E Schlenker,et al.  Initial home health outcomes under prospective payment. , 2005, Health services research.

[36]  David Nerenz,et al.  Learning to leverage existing information systems: Part 2. Case studies. , 2003, Joint Commission journal on quality and safety.

[37]  P. Stolee,et al.  The Use of Electronic Health Information Systems in Home Care: Facilitators and Barriers , 2010, Home healthcare nurse.

[38]  H P Lehmann,et al.  Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site , 2011, Applied Clinical Informatics.

[39]  Jesper Simonsen,et al.  Measurement of the Clinical Usability of a Configurable EHR , 2006, MIE.

[40]  L. Moody,et al.  Electronic Health Records Documentation in Nursing: Nurses' Perceptions, Attitudes, and Preferences , 2004, Computers, informatics, nursing : CIN.

[41]  Dean F. Sittig,et al.  Computerized Provider Order Entry Adoption: Implications for Clinical Workflow , 2008, Journal of General Internal Medicine.

[42]  Majd Alwan,et al.  Use of health information technology in home health and hospice agencies: United States, 2007 , 2010, J. Am. Medical Informatics Assoc..

[43]  Clement J McDonald,et al.  Computerization Can Create Safety Hazards: A Bar-Coding Near Miss , 2006, Annals of Internal Medicine.

[44]  Yukie Majima,et al.  Issues to be improved after introduction of a non-customized Electronic Medical Record system (EMR) in a Private General Hospital and efforts toward improvement. , 2006, Studies in health technology and informatics.

[45]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[46]  Elizabeth J Sassen Love, Hate, or Indifference: How Nurses Really Feel About the Electronic Health Record System , 2009, Computers, informatics, nursing : CIN.

[47]  Meridean Maas,et al.  Written and computerized care plans. Organizational processes and effect on patient outcomes. , 2002, Journal of gerontological nursing.

[48]  Marc Berg,et al.  Patient care information systems and health care work: a sociotechnical approach , 1999, Int. J. Medical Informatics.

[49]  Emily S. Patterson,et al.  Exploring barriers and facilitators to the use of computerized clinical reminders. , 2005, Journal of the American Medical Informatics Association : JAMIA.

[50]  Monique W. M. Jaspers,et al.  Development of a national protocol to screen Dutch cancer survivors on late cancer treatment effects , 2007, Int. J. Medical Informatics.

[51]  Marguerite C. Adelsberger,et al.  Impact of Homecare Electronic Health Record on Timeliness of Clinical Documentation, Reimbursement, and Patient Outcomes , 2014, Applied Clinical Informatics.

[52]  Elske Ammenwerth,et al.  Research Paper: Factors Affecting and Affected by User Acceptance of Computer-based Nursing Documentation: Results of a Two-year Study , 2003, J. Am. Medical Informatics Assoc..