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Table 11 Overview of all findings

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