Reasons behind failure of E.H.R adoption
Reasons behind the lack of adoption of the Electronic Health Record (EHR) vary according to patients’ settings. The settings are inpatients and outpatients but the adoption rates are too low in both cases. (Ash and Bites, 8) The main determining factors include but are not limited to variation in the strength, physicians’ concern over the workflow, and many other environmental issues. The computerized physician’s order entry systems (CPOE) are used as an alternative for the EHR where users will argue that it works similarly. On the other hand, augmented that the CPOE might not be in a position to perform some tasks such as decision-making support especially when there are third parties involved in entering data. For the same reason, it is said that CPOE would work better when merged with EHR. (Ash and Bites, 8)
Some of the environmental factors that hinder the implementation of EHR and are mostly connected to the outpatients include financial and safety issues. The outpatient system is faced with an uphill task when it comes to implementation costs since the recovery is very slow where mostly the financial recovery plans affect the payers and purchases as opposed to one that depends on the hospital and patients charges such as the inpatient’s system.
As much as electronic health is believed to be a major boost to the management of patient records and improvement of services, the environmental forces of competition in most health care systems is another hindrance to their implementation. Patients are becoming more aware of the potential consequences some health care information systems have. They know that they can get involved in their care. The computerized systems allow them to access parts of their records from any connected health facility systems to view their reports and edit them.
The greatest social problems users may be facing include the fear that the health system empowers them. It allows them to view and edit parts of their records. Experts would advise that the environmental trends are facilitating forces capable of bridging the gap.
One organizational hindering factor especially for the inpatient setting is the analysis of the risks involved. EHR may be the biggest single investment a hospital can make but according to Ash and Bites (10), many hospitals have lost their money through the investment. The investment is a financial risk that brings some social or behavioral risks of adoption since the users may not adopt it due to personal, technical, and organizational reasons. Most of these hospital systems lack a strong organizational culture to enhance and support implementation. Argumentatively users would outline that trust may be lacking among them and this compromises patient’s care and safety.
Newly established systems need ample moral and financial support from the management for their adoption. This aspect is probably lacking during implementation. The management ought to be in a better position to understand major and finer details concerning the system. The system may also lack supporting staff for it to pick up such as the support coordinators and clinical staff trainers who are competent enough in both technical and clinical issues.
The personal hindering factors include the feeling that the new system takes away the patient’s time. The biggest debate is whether the system is much faster than the manual one and in most instances the users settle for the manual saying they work similarly or the new system is even slower, which would probably be certain for any newly implemented system.
The technical hindering factors include the ability of both systems to operate concurrently. CPOE interoperates with output receiving systems such as laboratories pharmacies or radiology systems. Technically most already existing systems that are in use do not communicate well with the EHR thus making the communication between inpatients and outpatients to be infrequent. (Ash and Bites, 11)
Another hindering factor may include political and business influences over implementation. Some people out of their gain: mostly financial would not wish to have systems that share data.
Most important Reasons behind failure of E.H.R adoption
The technical issue is a significant hindrance since future operations would require interoperability among organizations. This is an issue that unless solved, then the system would not be significant or supportive to growth. We are in the technological world where people should perform an important task with ease regardless of location and time. Another issue to consider would be the personal hindering factors. Most physicians are not concerned with the financial issue since implementation or running cost does not affect them and security issues are also in most cases out-sourced. They support the system and its implementation but fail to use it because they feel that it consumes the majority of their time.
Failure of ‘Electronic Medical Record Tool to Improve Pain Assessment Documentation’
Patients felt that the system was very difficult to use, it did not change their pain assessment practice and this may have been the main hindrance of the documentation. Some of the evident factors include usability, workflow factors, and computer literacy. Underutilization due to these factors would have automatically led to inefficient surveillance and compliance. The system users would not have wanted their screening to take up more of their time therefore they were reluctant on the system since it increased their workflow. The lack of training and publication about the system could also have been another setback to utilization and a major cause of anxiety, therefore perceived as a major burden.
The domain to consider the implementation of such a system without difficulties would be user education and friendliness. In line with most of the surveys conducted, most users expressed the issue of workload with extra screens that made their work take long. A user-friendly system ought to be less tedious and without any extra steps, and should have a well-defined user interface such that it accommodates most if not all the descriptions provided by patients. (Saigh, Marc and Link Nathan, 185+)
Future implementation steps one would take for a similar system
Foremost, the initial system ought to be less complex for other functions to upgrade gradually as the users become accustomed to the system. To implement such a complex system, prototypes, which should have fewer data entry points, are used. Users understand and appreciate technology but the system is meant to make work easier and faster. It ought to have user-friendly interfaces where users mostly choose closely related options other than filling data.
Factors contributing to the success of Lestowel E.H.R
Some of the factors that contributed to the success story of Listowel’s Electronic Health Record system were first the existence of a project plan. Before the implementation of their main system Listowel, management interacted and made some systematic research from existing systems where they tried to have the patient’s perspective. Secondly, having professionals is also very important. Listowel hired experienced information system professionals to assist with network and hardware implementation.
They utilized the modular system of implementation where the systems upgrades were in phases starting from the most crucial and progressing gradually to the final system over a certain period. This way, the users adapt to the system at their own pace. They then utilized the phase implementation system where other departments integrated into the new system. (Annis et al, 2)
Availability of recourses especially funds for expansion and maintenance is very important. Listowel considered it was necessary to look for extra funds for its system investment. Lastly, critical areas such as the security policies were by the specialists’ guidance to ensure effectiveness. These are the factors, which contribute to the successful implementation of a system, and therefore the “Pain Assessment Documentation” project, to implement under a similar plan.
Annis, Rob., Boshart, Brent., and Williamson, June K, “Listowel: An Electronic Health Record Success Story” ELectronicHealthcare Longwoods Publishers vol.7 No 1. 2008.
Ash, Joan S., and Bites, David W. “Factors and Forces Affecting EHR System Adoption” Journal of the American Medical Informatics Association (JAMIA). 2004. Web.
Saigh, Orit., Triola, Marc M., and Link Nathan R. “Brief report: Failure of an Electronic medical record tool to improve pain assessment documentation” Journal of General Internal Medicine. Springer New York, 2006. Web.