Priorities and Strategies for the Implementation of Integrated Informatics and Communications Technology to Improve Evidence‐Based Practice

School of Public and Environmental Affairs, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, IN, USA
Journal of General Internal Medicine (Impact Factor: 3.42). 01/2006; 21(S2):S50 - S57. DOI: 10.1111/j.1525-1497.2006.00363.x
Source: PubMed


The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.

Download full-text


Available from: Bradley N Doebbeling
  • Source
    • "Analysis showed that during an interview, when providers turned away from patients to enter clinical data into the system, a natural conversation breakpoint occurred. Interestingly, the study suggested that this breakpoint allowed the patient time to think about the interview and add detail to it enhancing the transfer of information between patient and provider [37] [77]. The study observed physicians showing patients their patient record to reinforce physician comments [77]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria.
    Full-text · Article · Jan 2009 · International Journal of Medical Informatics
  • Source
    • "The purpose of this term is to identify significant patterns in data that could not be detected in other ways [2]. The use of informatics resources, especially those related with capture, storage and research of clinic data, has been extremely important on the production of high quality and trustful clinical studies [3] [4]. By these databases it is possible to obtain a structured collection of clinical information for posterior analysis, contributing to the quality of health care, evolution and solidification of technical scientific knowledge, and production of prospective studies with a larger amount of patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aims this paper is to display the apriori data mining method results implanted in SINPE© (Electronic Protocols Integrated System) in an Enteral Nutrition research. We developed the data mining in the SINPE and later the items body mass index (BMI or IMC) and Enteral diet were selected from the database of the Homecare Enteral Nutrition Research. The parameters used were 10% support and 50% confidence. The Apriori generated a rule showing that patients with BMI ¿ 22 kg/m2 implied the intake of a homemade diet. The application of the apriori data mining method shows itself more dynamic, allowing the data intersection, and helping on decisions and on the elaboration of diagnostics as well as on diet prescriptions, checking the possible relationships between the analyzed items.
    Full-text · Conference Paper · Jan 2009
  • Source
    • "While they are influenced by organizational structure, they tend to be more mutable as they refer to practice arrangements, referral procedures, service coordination, and other organizational actions. Using electronic medical records (EMRs) as an example, the number of computer workstations and types of software may be described as elements of organizational structure, but the ways in which they are used to deliver care (e.g., decision support capacities, communication processes between providers) represent organizational processes underlying health information technology [56]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Health care organizations exert significant influence on the manner in which clinicians practice and the processes and outcomes of care that patients experience. A greater understanding of the organizational milieu into which innovations will be introduced, as well as the organizational factors that are likely to foster or hinder the adoption and use of new technologies, care arrangements and quality improvement (QI) strategies are central to the effective implementation of research into practice. Unfortunately, much implementation research seems to not recognize or adequately address the influence and importance of organizations. Using examples from the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI), we describe the role of organizational research in advancing the implementation of evidence-based practice into routine care settings. Using the six-step QUERI process as a foundation, we present an organizational research framework designed to improve and accelerate the implementation of evidence-based practice into routine care. Specific QUERI-related organizational research applications are reviewed, with discussion of the measures and methods used to apply them. We describe these applications in the context of a continuum of organizational research activities to be conducted before, during and after implementation. Since QUERI's inception, various approaches to organizational research have been employed to foster progress through QUERI's six-step process. We report on how explicit integration of the evaluation of organizational factors into QUERI planning has informed the design of more effective care delivery system interventions and enabled their improved "fit" to individual VA facilities or practices. We examine the value and challenges in conducting organizational research, and briefly describe the contributions of organizational theory and environmental context to the research framework. Understanding the organizational context of delivering evidence-based practice is a critical adjunct to efforts to systematically improve quality. Given the size and diversity of VA practices, coupled with unique organizational data sources, QUERI is well-positioned to make valuable contributions to the field of implementation science. More explicit accommodation of organizational inquiry into implementation research agendas has helped QUERI researchers to better frame and extend their work as they move toward regional and national spread activities.
    Full-text · Article · Jun 2008 · Implementation Science
Show more