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Barriers and success factors in health information technology: A practitioner's perspective
Abstract
Healthcare information technology is a key factor in improving quality and reducing cost in healthcare, and yet, the successful implementation of health IT varies greatly among healthcare systems. A review of the health IT literature supplemented by an analysis of the experience of successful IT implementation in Maccabi Healthcare Services, reveals that, despite differences among countries, common barriers to implementation of health IT and common critical success factors can be identified. Barriers include lack of clear benefits, sufficient incentives and adequate support for clinicians as well as payer–provider relationships, marketplace competition and privacy legislation. Critical success factors are innovative leadership, integrated management and collaboration with the doctors based on concrete needs, benefits, incentives and support. Dilemmas for managers include proof of return on investment for health IT versus leadership and tough management decisions; the optimal balance in the tradeoff between market dynamics, competition and choice, and the value of an integrated system that can generate significant benefit to clinicians, patients and payers; and the appropriate balance between privacy and improved quality of care, including the reduction of clinical error.
... Within the healthcare sector the use of Information Technology (IT) is increasing (Kampmeijer et al., 2016;Nictiz, 2016). The use of electronic health records and IT health systems (e-health) has one of the highest priorities in modern healthcare organisations (Kaye et al., 2010). However, the adoption and implementation of healthcare technology seems to be going at a slow rate (Boonstra & Offenbeek, 2010;Nictiz, 2016). ...
... Within the healthcare sector the use of Information Technology (IT) is increasing (Kampmeijer et al., 2016;Nictiz, 2016). The use of electronic health records and IT health systems (e-health) has one of the highest priorities in modern healthcare organisations (Kaye et al., 2010). However, the adoption and implementation of healthcare technology seems to be going at a slow rate (Boonstra & Offenbeek, 2010;Nictiz, 2016). ...
This paper summarises the arguments and counterarguments within the scientific discussion on the issue of the implementation of Electronic Medical Records (EMR). The primary purpose of the research is to present a framework for gathering end-user requirements in EMR system implementation. The cross-geographical literature review demonstrates EMR system implementation to be a complicated task to manage. A systematic review of literature sources and approaches for solving the problem indicates that a lack of end-user participation often results in technology rollbacks. The failures to implement electronic medical records are considered to be the reasons for financial losses, followed by the rearrangements of key personnel. The author of the article investigates the role of the main actors involved in the healthcare process. Consequently, as the market adoption of EMRs grows and its impact as a workflow management tool in care facilities increases, focusing on end-user requirements during the implementation phase becomes essential. Investigation of the topic reveals that the opposing points of view, learning investments, and the embedded nature of older technologies deter users from accepting new technology. Methodological research tools involved studying the workflows in a regular outpatient journey. Taking the case of a standard outpatient facility, the paper attempts to present its results through a framework for requirement gathering in the pre-implementation stages. A plan of action for eliciting end-user requirements for the users in a three-stage framework is being proposed. Considering the diverse number of actors in the standard outpatient journey, the three-stage framework breaks down requirements by roles and educational backgrounds and gathers into 1) antecedent or existing conditions; 2) formal and informal communication channels; 3) user and system-generated requirements. This framework relies on synthesising existing frameworks and arranging them in sequential order for real-world implementations based on existing research papers.
Bu çalışmanın amacı sağlık bilgi teknolojilerinin temel bileşenlerinden biri olan internet ve mobil sağlık uygulamalarını etkileyen değişkenleri belirlemektir. Bu doğrultuda, kamu internet ve mobil sağlık uygulamalarını kullanmaya yönelik uyumu kolaylaştıran veya kullanım direncine yol açan; performans beklentisi, çaba beklentisi, sosyal etki, teknoloji kaygısı, gizlilik endişesi ve sağlık bilinci faktörleri incelenmiştir. Isparta ili merkezinde 627 örneklem sayısıyla 18 yaş üzeri bireylerin kamu internet ve mobil sağlık uygulamalarını kullanımını etkileyen faktörlerin ölçülmesi planlanmıştır. Verilerin kodlanarak değerlendirilmesi bilgisayar ortamında Statistical Package for the Social Sciences (SPSS 28.0) paket programı ve AMOS 26.0 programı kullanılarak gerçekleştirilmiştir. Kamu internet ve mobil sağlık uygulamalarını kullanımına yönelik tutum boyutlarını ve bu boyutlar altında yer alan faktörleri belirlemek için geçerlilik ve güvenilirlik analizleri, açımlayıcı faktör analizi ve doğrulayıcı faktör analizi yapılmış ve değişkenlerin ortalama ve standart sapmaları hesaplanmıştır. Kamu internet ve mobil sağlık uygulamalarının kullanım niyetine yönelik 6 alt boyutun 25 ifadesinin güvenirliğinin Cronbach’s Alpha katsayısının 0,765 olduğu bulunmuş verilerin normal dağılıma uygun olduğu parametrik testler yapılarak belirlenmiştir. Temel bileşenler analizi uygulamasıyla açımlayıcı faktör analizinde altı faktörün (performans beklentisi, çaba beklentisi, sosyal etki, teknoloji kaygısı, gizlilik endişesi ve sağlık bilinci) ortaya çıktığı görülmüştür. Faktörlerin tümü toplam varyansın %75,08’ini açıklamaktadır.
The digital transformation associated with the huge volume of data that healthcare organizations deal with today is based on transforming this complex knowledge-driven industry to turn data into knowledge. The healthcare industry requires comprehensive models that help identify priorities to implement business intelligence (BI) solution. Business intelligence can help organizations make better decisions by showing current and historical data within their business context. This paper systematizes and analyzes three business intelligence maturity models into one and also attempts to understand the main key performance indicators in adopting business intelligence maturity model in healthcare organizations. For this purpose, we present a questionnaire that was based on the systemized business intelligence maturity model that was sent to X% of the Portuguese hospitals with the objective of identifying not only the business intelligence maturity stage of the Portuguese hospitals but also to infer the most important key performance indicators that will characterize each stage.KeywordsBusiness intelligenceMaturity modelsHealth care
Botswana is concerned about the continuously escalating failure rate of
children in basic education [grades 1–12], despite the introduction of technology in
some schools. The efforts made have no significant change in the performance of
children in schools. Basarwa and Bakgalagadi children l¦ive in abject poverty and
rely solely on government’s handouts such as food baskets. Inequality and extreme
poverty are prevalent in both rural and urban areas. The Basarwa and Bakgalagadi
in the Kgalagadi desert have no opportunities for employment or resources they can
utilize to change their economic status. The Kgalagadi areas are rich in wildlife,
but there is no economic gain from the available natural resources and most of their
basic needs are provided for by the government. The culture of the Basarwa is unique
in that they speak various indigenous languages and are a very closely-knit ethnic
group. Some children leave boarding schools to return home to their parents because
they miss their families, and this affects their performance. Most of the Basarwa and
Bakgalagadi parents are illiterate and do not value education. Factors leading to poor
performance have been established. This study utilized qualitative research methods
in one Basarwa settlement area as a case study to establish why Basarwa children
failed to complete their education.
The objective of this chapter is to share the management principles for implementing Health Information Technology (HIT) that derive from first-hand experience in implementing Health IT in Israel and in Scotland. Both were among the early adopters of Health IT. While the structures of their healthcare systems are very different and there were differences in implementation approaches, there were also commonalities. Scotland’s implementation has been predominantly top-down and Israel’s implementation has been bottom-up. Scotland has developed iterative strategies at the national level, whereas Health IT in Israel has been from grass roots, driven by the four HMOs. While both countries implemented both Health Information management systems and telemedicine, Scotland placed higher priority on telehealth and Israel prioritized shared electronic medical records supported by clinical decision support systems. Common implementation principles included: leadership, focusing on compelling needs, collaboration, embedding IT in ongoing organizational processes, and providing training and ongoing support.KeywordsHealth ITeHealthTelecareTelemedicineImplementationLeadershipManagement Principles
The purpose of this study is to investigate the relationship between owner-manager control and nonfamily member employees’ affective commitment in small
family business. It is frequently stated in the family business literature that family
business is different from nonfamily business, and that these differences can significantly impact outcomes. Based on this assumption, this study examines the extent to
which that is true in the case of managerial control and its relationship to employees’
affective commitment. The research design incorporated a quantitative correlational
approach using survey data. The study uses a survey with a 177-sample population of
the non-family employee who works at the small family business in the foodservice
sector located across Victoria, Australia. The results show that there is a positive
correlation between managerial capability controls, the relationship quality (LMX),
and the affective commitment.
The seminal findings indicate that both Danish and Albertan physicians engaged with computers in the early 1990s; however, in Alberta the emphasis was on the recording of diagnosis and visit date for the purpose of payment for services by the provincial government, while in Denmark the emphasis was on creating an exchange mecha- nism between physicians utilizing existing standard protocols. In Denmark, physi- cians rapidly adopted locally provided EMRs, while in Alberta physicians retained paper records until the introduction of a standard process for reimbursing the costs of extended computer capability in 2001. While many of their peers in adjacent provin- cial or European Union country jurisdictions have languished with respect to EMR adoption, these two trajectories have led to nearly 100% of EMR adoption by general practitioners in Denmark as early as 2000 and 60% adoption by primary care physi- cians in Alberta by 2006. An evaluation of the similarities and differences points to various factors that have contributed to the rate of adoption of primary care physi- cian office computing that may be important for future evaluations in other settings
This is the last in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper introduces a unique comparison instrument developed for this study using the best evidence available namely data was pulled from centralised databases and was indisputable (e.g. percentage of primary care physicians who send medication prescriptions electronically to pharmacies). Where the data was simply not available, estimates were made. Since the reliability of the data on the use of computers by primary care physicians is so variable and in some case simply not available, the authors also introduce the use of a Cochrane-like confidence factor (CF) to each comparison measure. The paper draws particular attention to the fact that both countries have a highly visible central unifying body or what might be called a Health System Integrator; though Denmark s Medcom is a pseudo government agency New Zealand's HealthLink is a private company, both play critical roles in the success story of these two countries.
In the 3 decades since the term “medical informatics” was
first used, individuals working at the intersection of information technology
(IT) and medicine have developed and evaluated computer applications aiming
to improve health and health care.1 The road
to successful use of IT in medicine has not been easy, with examples of failures
in both computer systems and networks.2- 3 However,
a variety of applications from the field of medical informatics have matured
in recent years.4
It is generally acknowledged that Denmark is one, if not the, leading country in terms of the use of information technology by its primary care physicians. Other countries, notably excluding the United States and Canada, are also advanced in terms of electronic medical records in general practitioner offices and clinics.
This paper compares the status of primary care physician office computing in Andalucía to that of Denmark by contrasting the functionality of electronic medical records (EMRs) and the ability to electronically communicate clinical information in both jurisdictions.
A novel scoring system has been developed based on data gathered from databases held by the respective jurisdictional programs, and interviews with individuals involved in the deployment of the systems. The scoring methodology was applied for the first time in a comparison of the degree of automation in primary care physician offices in Denmark and the province of Alberta in Canada. It was also used to compare Denmark and New Zealand. This paper is the third offering of this method of scoring the adoption of electronic medical records in primary care office settings which hopefully may be applicable to other health jurisdictions at national, state, or provincial levels.
Although similar in many respects, there are significant differences between these two relatively autonomous health systems which have led to the rates of uptake of physician office computing. Particularly notable is the reality that the Danish primary care physicians have individual "Electronic Medical Records" while in Andalucía, the primary care physicians share a common record which when secondary care is fully implemented will indeed be an "Electronic Health Record".
It is clear that the diffusion of technology, within the primary care physician sector of the health care market, is subject to historical, financial, legal, cultural, and social factors. This tale of two places illustrates the issues, and different ways that they have been addressed.
Drug interactions have been shown to be preventable by computerized prescription entry and screening only in hospitals and not in community-based practice.
We retrospectively evaluated the effect of online prescription screening in community pharmacies and physician offices of one health maintenance organization, phased in during 3 consecutive 6-month periods in 1998 to 1999 (period I, system active only in 40% of pharmacies; period II, system active in 90% of pharmacies and 50% of physician offices; period III, system active in 95% of pharmacies and 90% of physician practices), on rates of prescriptions with-, patient exposure to-, and physician prescribing of-potential drug interactions.
Cumulative data included 775,186 patients given at least one prescription, by one or more of 5504 physicians, whose prescriptions were dispensed at 572 pharmacies. Dispensing of drug interaction prescriptions was reduced by 21.1% and by 67.5% in periods II and III compared with period I (odds ratio, 0.79; 95% confidence limit, 0.75-0.83 and odds ratio, 0.28; 95% confidence limit, 0.26-0.30, respectively). Patient exposure decreased only in those receiving 3 to 7 concurrent drugs (odds ratio, 0.80; 95% confidence limit, 0.71-0.90) with no reductions for patients who were given 2 drugs or 8 or more drugs. Only 19% to 25% of physicians wrote prescriptions for drugs that interact, but 85% of these repeated this pattern after being alerted. The proportion of prescriptions of drugs that interact that originated with a single prescriber, as opposed to 2 prescribers, decreased during the 3 periods from 0.81 to 0.74 and 0.69 (P <.001).
Computerized prescription entry and drug interaction screening in the community caused a 62.8% reduction in pharmacy-dispensed prescriptions with severe drug interactions and a 20% reduction in patient exposure to prescriptions with severe drug interactions; this reduction was negated by polypharmacy of 8 or more drugs. The effect of interaction alerts on physician prescribing patterns was limited.
Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates.
We identified trials that evaluated the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles. Studies were included for systematic review if the design was a randomized controlled trial, a nonrandomized controlled trial, or an observational study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (eg, medication errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements.
Five trials assessing CPOE and 7 assessing isolated CDSSs met the criteria. Of the CPOE studies, 2 demonstrated a marked decrease in the serious medication error rate, 1 an improvement in corollary orders, 1 an improvement in 5 prescribing behaviors, and 1 an improvement in nephrotoxic drug dose and frequency. Of the 7 studies evaluating isolated CDSSs, 3 demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and 1 an improvement in theophylline-associated medication errors. The remaining 3 studies had nonsignificant results.
Use of CPOE and isolated CDSSs can substantially reduce medication error rates, but most studies have not been powered to detect differences in adverse drug events and have evaluated a small number of "homegrown" systems. Research is needed to evaluate commercial systems, to compare the various applications, to identify key components of applications, and to identify factors related to successful implementation of these systems.