From: Implementing electronic health records in hospitals: a systematic literature review
Author | Findings | Category |
---|---|---|
Ash et al. [23] | Trust between administrators and physicians seems to be a necessary ingredient tot successful implementation. | A4 |
Ash et al. [24] | Organizational issue fostering implementation: a strong culture | A4 |
Ash et al. [24] | Organizational issue fostering implementation: a history of collaboration and teamwork | A4 |
Boyer et al. [25] | A favorable strategic factor is creating a favorable organizational culture. | A4 |
Boyer et al. [25] | The establishment of a multidisciplinary team to deal with her related issues prevents conflict and stimulates collaboration. | A5 |
Ford et al. [27] | For-profit hospitals are half as likely to have fully implemented an EHR as their nonprofit counterparts. | A1 |
Ford et al. [27] | System-affiliated hospitals were 31 percent more likely than were unaffiliated facilities to have successfully implemented an EHR. | A1 |
Gastaldi et al. [28] | Willingness to avoid pure cost-oriented vendors. | A2 |
Gastaldi et al. [28] | Diffused pressures to realize the EMR as soon as possible, because physicians’ data sharing is needed. | A6 |
Houser & Johnson [29] | Rural hospitals are less likely to have completed implementation of an EHR system compared to urban and suburban hospitals. | A1 |
Houser & Johnson [29] | Government-owned or not-for-profit hospitals more often implemented a complete EHR system compared to for-profit hospitals. | A1 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of knowledge of EHR systems. | A3 |
Jaana et al. [30] | Critical Access Hospitals (CAH) in Iowa have significantly lower EMR levels compared to non-CAHs. | A1 |
Jaana et al. [30] | A higher number of staffed beds and available slack resources is positively associated with higher clinical IS scores and EMR levels. | A1 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is the local hospital control of selection of the system. | A2 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is previous computer or EMR experience. | A3 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is the academic medical centre being more change ready. | A1 |
Poon et al. [33] | A barrier to implementing CPOE is product and vendor immaturity. | A2 |
Poon et al. [33] | Product and vendor immaturity can be overcome by selecting a vendor who is committed to the CPOE market. | A2 |
Poon et al. [33] | Product and vendor immaturity can be overcome by ensuring a long-term trusting relationship of the vendor with the hospital. | A2 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by quality of care. | A6 |
Scott et al. [35] | The organizational culture of cooperative values minimized resistance to change early on. | A4 |
Takian et al. [37] | In order to successfully implement an EHR stakeholders, and their computer literacy and ability to access the technology, need to be identified prior to planning to procure and implement EHR software. | A3 |
Ward et al. [38] | Nurses who had previous experience with EHRs at other hospitals expressed more positive views towards an EHR. | A3 |
Ward et al. [38] | Nurses with more years of health care experience had less favorable perceptions towards an EHR compared to nurses with less years of experience. | A3 |
Ward et al. [39] | The staff perceived the EHR/CPOE implementation not to have disrupted the existing care processes. | A6 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is an uncooperative or computer phobic attitude of physicians. | A3 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is bureaucracy preventing change and interdepartmental conflict. | A5 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is health care providers that don’t know how to type. | A3 |
Weir et al. [19] | Support staff identify the barrier bureaucracy significantly more often than physicians. | A5 |
Aarts et al. [21] | Implementation of a CPOE is both a social process and contains technical issues, which increases complexity. | B1 |
Aarts et al. [21] | Creating fit between technology and work practices is a key factor for successful implementation of information systems. | B1 |
Ash et al. [24] | Technical/implementation issue fostering implementation: speed of the system | B2 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the ability to group orders into order sets | B3 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the possibility to make clinical pathways available to health care teams, | B3 |
Ash et al. [24] | Technical/implementation issue fostering implementation: the possibility to enter orders from remote locations. | B2 |
Ash et al. [24] | Organization of information issue fostering implementation: the information must be organized in a manner designed to mimic the way in which people use the information, which is generally not in a structured, hierarchical manner. | B3 |
Boyer et al. [25] | The technical aspects of an EMR have an important place but do not necessarily guarantee a successful implementation of EMR. | B2 |
Boyer et al. [25] | A barrier in implementing an EMR is less confidentiality in information sharing between patient and professional. | B4 |
Cresswell et al. [26] | A barrier in implementing an EHR is limited ability to customize the software. | B1 |
Gastaldi et al. [28] | Being able to deal with technical problems related to the customization of the system. | B1 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of structured technology. | B2 |
Houser & Johnson [29] | Perceived barriers of implementing an EHR system are privacy and confidentiality issues. | B4 |
Katsma et al. [31] | Compatibility of the EPR with working processes can also be reached by changing the work processes. | B1 |
Ovretveit et al. [32] | A factor in implementing an EMR system is the ease of navigation, efficiency in use and accessibility of the system. | B3 |
Ovretveit et al. [32] | A factor in implementing an EMR system is the absence of failures | B2 |
Ovretveit et al. [32] | A factor in implementing an EMR system is physicians’ acceptance and implementer’s responsiveness to concerns. | B5 |
Poon et al. [33] | Product and vendor immaturity can be overcome by having the vendor willing to adapt its product to hospital workflow issues. | B5 |
Scott et al. [35] | Software design and development problems increased local resistance. | B2 |
Takian et al. [37] | EHR needs to be seen as a sociotechnical entity by stakeholders, ensuring a user-centered design of EHR. | B1 |
Takian et al. [37] | Because of the huge cultural shift an EHR brings to heavily text-based notes, healthcare practitioners must be educated and protected with regards to transparency and observing confidentiality of patient notes. | B4 |
Takian et al. [37] | The safety of information access to EHR systems needs to be ensured prior to and during the implementation. | B2 |
Weir et al. [19] | A facilitating factor associated with implementation of a CPOE is sufficient functionality of the system. | B3 |
Weir et al. [19] | A facilitating factor associated with l implementation of a CPOE is the ability to customize software to meet physician needs. | B1 |
Weir et al. [19] | A facilitating factor associated with implementation of a CPOE is adequate hardware, terminals, etc. | B2 |
Weir et al. [19] | A barrier to implementation of a CPOE is insufficient functionality of the software. | B3 |
Weir et al. [19] | A barrier to implementation of a CPOE is having an insufficient number of terminals, a too slow system, and non-portable screens. | B2 |
Weir et al. [19] | A barrier to implementation of a CPOE is a user-unfriendly system. | B3 |
Weir et al. [19] | A barrier to implementation of a CPOE is a too labor intensive program. | B3 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains sufficient hardware, technical equipment, support and training. | B2 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains adequate safeguards for patient privacy. | B4 |
Aarts et al. [21] | Emergent change is a key characteristic of implementing information systems in complex organizations. | C4 |
Ash et al. [24] | Organizational issue fostering implementation: supportive leadership | C1 |
Boyer et al. [25] | The strategy used for EMR implementation is particularly important | C4 |
Boyer et al. [25] | A favorable strategic factor is active involvement of the manager. | C1 |
Boyer et al. [25] | A favorable strategic factor is regularly assessing the views of professionals to identify problems and develop support for corrective action. | C2 |
Cresswell et al. [26] | Allowing intensive user involvement in software design is favorable for embedding the system of time (particularly in smaller scale implementations). | C2 |
Cresswell et al. [26] | Acceptance of initially parallel use of paper during the implementation. | C4 |
Cresswell et al. [26] | Resistance of powerful users can lead to ‘workarounds’ | C6 |
Cresswell et al. [26] | There is time and resources available to let the users familiarize with the system. | C8 |
Gastaldi et al. [28] | Engagement of the whole organization in the process is crucial (both the creation as well as the maintenance). | C2 |
Gastaldi et al. [28] | Management of the change is crucial, particularly its initial communication. | C4 |
Gastaldi et al. [28] | Initial technological resistance of the physicians is a problem. | C6 |
Gastaldi et al. [28] | Understanding of the physicians’ necessities is important. | C6 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of employee training. | C3 |
Katsma et al. [31] | Development paradigm implementation approaches go hand in hand with high levels of implementation. | C4 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is employee involvement in many different ways. | C2 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is leadership and support by a competent on site information technology department. | C5 |
Ovretveit et al. [32] | A helping factor in implementing an EMR system is decisive and full leadership backing. | C1 |
Ovretveit et al. [32] | A factor in implementing an EMR system is user involvement in selection and development. | C5 |
Ovretveit et al. [32] | A factor in implementing an EMR system is providing education at the right times, amount and quality. | C3 |
Ovretveit et al. [32] | A factor in implementing an EMR system is strong management support. | C1 |
Simon et al. [36] | The entity that manages the implementation of CPOE needs to have representation from among the staff members (front line representation). | C2 |
Simon et al. [36] | Training end-users is important; providing real-time support is even more important. | C3 |
Simon et al. [36] | CPOE implementation requires a great deal of planning and preparation in advance. | C4 |
Simon et al. [36] | Multi-disciplinary representation of front line users and collaboration is important for the implementation of CPOE. | C5 |
Simon et al. [36] | Awareness of attitudes of anxiety and fear is important in the planning of the implementation of CPOE. | C6 |
Simon et al. [36] | The identification and support of a champion among each user group. | C7 |
Simon et al. [36] | The ample presence of live, in-person support (super-users) is helpful in facilitating the CPOE implementation. | C8 |
Scott et al. [35] | The initial selection of the CIS was perceived to be detached from the local environment resulting in conflicting priorities between the organization and individual physicians. | C2 |
Scott et al. [35] | Participatory leadership was valued for selection decisions. | C1 |
Scott et al. [35] | Hierarchical leadership was valued for implementation. | C1 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is knowledgeable, cheerful support from the Information Resource Management department. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is supportive administration and chiefs of staff. | C1 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is direct involvement of physicians. | C2 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is a good working relationship with developers. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is an interdisciplinary, effective implementation group. | C5 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is a good implementation strategy. | C4 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is support by medical administration and other allied fields. | C2 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is mandatory implementation. | C4 |
Weir et al. [19] | A facilitating factor associated with the implementation of a CPOE is good training and instruction. | C3 |
Weir et al. [19] | A barrier to the implementation of a CPOE is inadequate training, insufficient material, and residents rotation. | C3 |
Weir et al. [19] | A barrier to the implementation of a CPOE is the lack of effective, cheerful Information Resource Management support. | C5 |
Weir et al. [19] | A barrier to the implementation of a CPOE is non-supportive section chiefs of staff. | C1 |
Weir et al. [19] | Support staff identifies the facilitating factor organized, interdisciplinary implementation group significantly more often than physicians. | C5 |
Weir et al. [19] | Physicians identify the facilitating factor support of chiefs of staff and medical administration significantly more often than support staff. | C1 |
Weir et al. [19] | Physicians identify the facilitating factor mandatory implementation significantly more often than support staff. | C4 |
Weir et al. [19] | A facilitating factor associated with successful implementation of a CPOE is having a sufficient number of people for implementation and user training. | C8 |
Weir et al. [19] | A barrier to successful implementation of a CPOE is insufficient personnel to adequately implement the system and train people. | C8 |
Weir et al. [19] | Support staff identifies the facilitating factor sufficient personnel for implementation significantly more often than physicians. | C8 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains effective, clear communication. | C4 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains careful planning for system migration. | C4 |
Yoon-Flannery et al. [40] | EHR implementation best practice contains a sustainable business plan. | C4 |
Aarts & Berg [22] | Accepting or rejecting an information system will depend on whether those involved in the medical work practices will accept a transformation of these practices. | C6 |
Ash et al. [24] | Clinical/Professional issue fostering implementation: customization and the ability to adapt POE at the local level, creating acceptance among physicians. | C6 |
Houser & Johnson [29] | A perceived barrier of implementing an EHR system is the lack of support from medical staff. | C6 |
Ovretveit et al. [32] | A facilitating factor in implementing an EMR system is having adequate people and financial resources. | C8 |
Poon et al. [33] | A barrier to implementing CPOE is physician and organizational resistance. | C6 |
Poon et al. [33] | Physician and organizational resistance can be overcome by addressing workflow concerns. | C6 |
Aarts et al. [21] | The implementation process of a CPOE is highly unpredictable, influenced by contingencies that were not expected nor planned for. | C4 |
Ovretveit et al. [32] | A factor in implementing an EMR system is having a physician champion. | C7 |
Poon et al. [33] | Physician and organizational resistance can be overcome by strong leadership. | C1 |
Poon et al. [33] | Physician and organizational resistance can be overcome by identifying physician champions. | C7 |
Poon et al. [33] | Physician and organizational resistance can be overcome by leveraging house staff or hospitalists. | C8 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by physicians’ medical dominance. | C1 |
Rivard et al. [34] | The difficulty of a CIS implementation is explained by other health professionals’ professional status and autonomy. | C1 |
Takian et al. [37] | Contextualization and taking heterogeneity across mental health settings is crucial to implement EHR initiatives, it might help identify areas in need of additional support. | C4 |