Annotated Bibliography: Electronic Health Record Implementation
Anne Morrissette
Bon Secours Memorial College of Nursing
I pledge.
Blackford Middleton, Meryl Bloomrosen, Mark A Dente, Bill Hashmat, Ross Koppel, J Marc Overhage, Thomas H Payne, S Trent Rosenbloom, Charlotte Weaver, Jiajie Zhang; Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8. doi: 10.1136/amiajnl-2012-001458
The authors of this article are part of a Task Force that the AMIA Board of Directors convened to examine evidence from literature and make recommendation on the usability of electronic health record systems. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. The main purpose of this article was to address the issue of user-friendly access and form the basis of a plan to increase understanding of the impact of usability on the effective use of health IT; this would lead to safer and higher quality care in the healthcare field. This article is relevant to the topic as it is based on EHR’s implementation in the healthcare setting, the application’s design and access, and the relationship of usability to optimal healthcare practice. The standpoint of the authors is that the adoption of useful and usable EHR will lead to safer and higher quality care, and a better return on investment for institutions that adopt them. Their recommendations for increasing satisfaction range from developing a common user interface style guide for select EHR functionalities, policy changes, to end-users Adopting best practices for EHR system implementation and ongoing management. This article is written to those in the medical field, particularly those who are currently using EHR’s and those that have yet to implement the program. The summary of the article is that patient safety and the usability of EHR aim to stimulate ongoing and informed discussions and bring about increased understanding of the impact of usability on the safe and effective use of EHR systems. Furthermore, after reviewing the issues reported by end-users, vendors, and several federal agencies, the authors recommend that the diverse activities already underway become more coordinated to collectively address the AMIA recommendations to increase the EHR’s implementation.
Derek W Meeks, Amirhossein Takian, Dean F Sittig, Hardeep Singh, Nick Barber; Exploring the sociotechnical intersection of patient safety and electronic health record implementation. J Am Med Inform Assoc 2014; 21 (e1): e28-e34. doi: 10.1136/amiajnl-2013-001762
The authors of this article are qualified in the medical field, Health Sciences, Biomedical Informatics, and Department of Practice and Policy. The main purpose of the authors work is to explore the complexity of the electronic health records correlation with patient safety and to examine and understand the applicability of two previously developed conceptual models in regards to safety implications. This article is relevant to the topic as the authors investigate the sociotechnical features of safe EHR implementation and the multifaceted interactions of technology within a healthcare organization evolving from paper to integrated EHR. The authors standpoint is that patient safety improvement activities as well as patient safety hazards change and improve as an organization evolves from concerns about safe EHR functionality, ensuring safe and applicable EHR use, to using the program itself to provide ongoing surveillance and monitoring of patient safety. The authors have written this article mainly to those in the medical field. They demonstrated the validity of two conceptual prototypes for understanding the social and technical aspects of safe EHR implementation and the complex interactions of technology within a healthcare system. This article’s summary is one of which examines the intersection of patient safety with practical conceptual models and how it can advance the EHR-enabled healthcare system towards the goal of advancing patient safety by use of safe technology and the user’s safe use of the program as well.
McAlearney, A., Hefner, J., Sieck, C., & Huerta, T. (2015). The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50(2), 462-488. doi: 10.1111/1475-6773.12227
The authors of this article are educated in health related fields and conducted a qualitative research for health services. The main purpose is to provide extensive evidence after conducting focused interviews that prove EHRs significance by modeling EHR adoption as loss through the lens of Kübler-Ross’s five stages of grief mode. Coupled with Kotter’s eight-step change management framework, the authors offer a structure to facilitate organizations’ movement through the EHR implementation journey. Combining insights from these frameworks, they identify 10 EHR strategies that help address EHR implementation barriers. Furthermore, improving the comprehension of facilitators of EHR system implementation – paying particular attention to opportunities to amplify physician adoption and efficient deployment. The article is relevant to the topic as it demonstrates the electronic health records benefits and the difficulties of adopting it by medical fields. By modeling Kubler-Ross’s model, the authors found that implementation in stages using the lenses of both organizational and personal change models can be useful to physicians struggling to progress through the required steps of personal change, as well as to organizations challenged to maximize physicians’ adoption and use of the new system. This article is mainly written to the medical professionals and development software employees as evidence of the stressors that new program implementation can have, but seeks to solve by recommending following the stages of grief. The summary of this article and what the authors had found is that for both the organization and individual, the introduction, adoption, implementation, and use of EHRs involve change which can cause stress. As the changes involved are both personal and organizational, their findings recommend that change principles can help clarify the steps involved and facilitate physicians’ adoption and optimal use of EHR systems.
Reed M, Huang J, Brand R, Graetz I, Neugebauer R, Fireman B, Jaffe M, Ballard DW, Hsu J. Implementation of an Outpatient Electronic Health Record and Emergency Department Visits, Hospitalizations, and Office Visits Among Patients With Diabetes. JAMA. 2013;310(10):1060-1065. doi:10.1001/jama.2013.276733
The authors of this article all hold a PhD and are contributing to an EHR study for the Division of Research at Kaiser Permanente. The main purpose of this article is to explore EHRs benefits in relation to improving patient health outcomes on limited and inconsistent evidence. The authors are targeting a specific group, patients with diabetes mellitus, and examining the association between implementing a commercially available outpatient EHR and ED visits, hospitalizations, and office visits. This method is used to examine patient health outcomes in correlation to utilization of an EHR. Although looking at just a particular group for this study, this article is relevant to the topic as it is based on EHR’s implementation in the outpatient setting, exploring further benefits outside of inpatient, and examining the improvement made in patient health outcomes by numbers of medical visits. The standpoint of the authors is that among patients with diabetes, use of an outpatient EHR in an integrated delivery system might be associated with better results as the program promotes easier accessibility, therefore creating better management of their chronic condition; a medical condition in which improved care could reduce spending and reductions in ED visits and hospitalizations.. This article is written to those in the medical field, focusing on diabetes mellitus and the frequency of visits in relations to EHR outpatient implementation. The summary of the article is that after conducting a study that included a statistical analysis of the results, use of an outpatient EHR in an integrated delivery system was associated with only modest reductions in ED visits and hospitalizations but not office visit rates. The authors recommend further studies are needed to quantify the association of EHR use with changes in costs.
Ryan, M., Andrew, Mccullough, M., Colleen, Shih, C., Sarah, Wang, J., Jason, Ryan, S., Mandy, & Casalino, P., Lawrence. (2014). The Intended and Unintended Consequences of Quality Improvement Interventions for Small Practices in a Community-based Electronic Health Record Implementation Project. Medical Care, 52(9), 826-832. doi: 10.1097/MLR.0000000000000186
The authors of this article hold doctorate and master’s degrees in the division of public health and are therefore educated in a community’s health and outcomes. The main purpose of this article is to examine whether the implementation of EHRs and corresponding interventions, including clinical decision support, technical assistance, and financial incentives, improved the quality of care in small practices. This article is relevant to EHR implementation as it evaluates the increased adoption of the program in the medical field and quantifies the improvements made in healthcare. Using data from 2009 to 2011, the study included 143 practices, separating 71 of them to receive financial incentives and quality feedback and 72 were randomized to feedback alone. The authors then estimated measure-level fixed effect models and the association between exposure to clinical decision support, technical assistance, financial incentives, and quality of care. The standpoint of the authors is the recognition of the rapid rise in the adoption of EHRs and that whether they contribute to better quality and lower costs is debatable. This article is written to anyone in the medical field who has been using the EHR program or those who may be considering it. The summary of what the authors found is that technical assistance and financial incentives, alongside EHR implementation, can improve quality of care, although financial incentives for quality may not result in similar improvements for incentivized and un-incentivized measures.