Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Topic: Implementing Electronic Health Records at St. Hampton’s Hospital

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CHAPTER 13 – CASE STUDY

IMPLEMENTING ELECTRONIC HEALTH RECORDS AT ST. HAMPTON’S HOSPITAL

The literature on implementing Electronic Health Records (EHR) in hospitals is very diverse. The objective of this study is to create an overview of the existing literature on EHR implementation in hospitals and to identify generally applicable findings and lessons for implementers.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

 

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Methods

A systematic literature review of empirical research on EHR implementation was conducted. Databases used included Web of Knowledge, EBSCO, and Cochrane Library. Relevant references in the selected articles were also analyzed. Search terms included Electronic Health Record (and synonyms), implementation, and hospital (and synonyms). Articles had to meet the following requirements: (1) written in English, (2) full text available online, (3) based on primary empirical data, (4) focused on hospital-wide EHR implementation, and (5) satisfying established quality criteria.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Results

Of the 364 initially identified articles, this study analyzes the 21 articles that met the requirements. From these articles, 19 interventions were identified that are generally applicable and these were placed in a framework consisting of the following three interacting dimensions: (1) EHR context, (2) EHR content, and (3) EHR implementation process.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Conclusions

Although EHR systems are anticipated as having positive effects on the performance of hospitals, their implementation is a complex undertaking. This systematic review reveals reasons for this complexity and presents a framework of 19 interventions that can help overcome typical problems in EHR implementation. This framework can function as a reference for implementers in developing effective EHR implementation strategies for hospitals.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Keywords

  • Clinical Staff
  • Electronic Health Record
  • Electronic Patient Record
  • Health Information Technology
  • Computerize Physician Order Entry Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Background

In recent years, Electronic Health Records (EHRs) have been implemented by an ever increasing number of hospitals around the world. There have, for example, been initiatives, often driven by government regulations or financial stimulations, in the USA [1], the United Kingdom [2] and Denmark [3]. EHR implementation initiatives tend to be driven by the promise of enhanced integration and availability of patient data [4], by the need to improve efficiency and cost-effectiveness [5], by a changing doctor-patient relationship toward one where care is shared by a team of health care professionals [5], and/or by the need to deal with a more complex and rapidly changing environment  Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

EHR systems have various forms, and the term can relate to a broad range of electronic information systems used in health care. EHR systems can be used in individual organizations, as interoperating systems in affiliated health care units, on a regional level, or nationwide [12]. Health care units that use EHRs include hospitals, pharmacies, general practitioner surgeries, and other health care providers Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

The implementation of hospital-wide EHR systems is a complex matter involving a range of organizational and technical factors including human skills, organizational structure, culture, technical infrastructure, financial resources, and coordination [89]. As Grimson et al. [5] argue, implementing information systems (IS) in hospitals is more challenging than elsewhere because of the complexity of medical data, data entry problems, security and confidentiality concerns, and a general lack of awareness of the benefits of Information Technology (IT). Boonstra and Govers [10] provide three reasons why hospitals differ from many other industries, and these differences might also affect EHR implementations. The first reason is that hospitals have multiple objectives, such as curing and caring for patients, and educating new physicians and nurses. Second, hospitals have complicated and highly varied structures and processes. Third, hospitals have a varied workforce including medical professionals who possess high levels of expertise, power, and autonomy. These distinct characteristics justify a study that focuses on the identification and analysis of the findings of previous studies on EHR implementation in hospitals.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Study aim, theoretical framework, and terminology

In dealing with the complexity of EHR implementation in hospitals, it is helpful to know which factors are seen as important in the literature and to capture the existing knowledge on EHR implementation in hospitals. As such, the objective of this research is to identify, categorize, and analyze the existing findings in the literature on EHR implementation processes in hospitals. This could contribute to greater insight into the underlying patterns and complex relationships involved in EHR implementation and could identify ways to tackle EHR implementation problems. In other words, this study focusses on the identification of factors that determine the progress of EHR implementation in hospitals. The motives behind implementing EHRs in hospitals and the effects on performance of implemented EHR systems are beyond the scope of this paper.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

 

 

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To our knowledge, there have been no systematic reviews of the literature concerning EHR implementation in hospitals and this article therefore fills that gap. Two interesting related review studies on EHR implementation are Keshavjee et al. [11] and McGinn et al. [12]. The study of Keshavjee et al. [11] develops a literature based integrative framework for EHR implementation. McGinn et al. [12] adopt an exclusive user perspective on EHR and their study is limited to Canada and countries with comparable socio-economic levels. Both studies are not explicitly focused on hospitals and include other contexts such as small clinics and national or regional EHR initiatives.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

This systematic review is explicitly focused on hospital-wide, single hospital EHR implementations and identifies empirical studies (that include collected primary data) that reflect this situation. The categorization of the findings from the selected articles draws on Pettigrew’s framework for understanding strategic change [13]. This model has been widely applied in case study research into organizational contexts [14], as well as in studies on the implementation of health care innovations [15]. It generates insights by analyzing three interactive dimensions – contextcontent, and process – that together shape organizational change. Pettigrew’s framework [13] is seen as applicable because implementing an EHR artefact is an organization-wide effort. This framework was specifically selected for its focus on organizational change, its ease of understanding, and its relatively general dimensions allowing a broad range of findings to be included. The framework structures and focusses the analysis of the findings from the selected articles.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

An organization’s context can be divided into internal and external components. External context refers to the social, economic, political, and competitive environments in which an organization operates. The internal context refers to the structure, culture, resources, capabilities, and politics of an organization. The content covers the specific areas of the transformation under examination. In an EHR implementation, these are the EHR system itself (both hardware and software), the work processes, and everything related to these (e.g. social conditions). The process dimension concerns the processes of change, made up of the plans, actions, reactions, and interactions of the stakeholders, rather than work processes in general. It is important to note that Pettigrew [13] does not see strategic change as a rational analytical process but rather as an iterative, continuous, multilevel process. This highlights that the outcome of an organizational change will be determined by the context, content, and process of that change. The framework with its three categories, shown in Figure 1, illustrates the conceptual model used to categorize the findings of this systematic literature review.Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Case Scenario:Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

Assume that you are the project manager at St. Hampton’s Hospital, located in a large city in the Midwest area of the United States. Your project team has been tasked with implementing electronic medical records (EMR) at St. Hampton’s. The information technology infrastructure is in place and the EMR software has been purchased. Your project focuses on implementation and adoption of EMR across the entire hospital (15 departments).
Questions:Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

1. Explain how you would determine appropriate objectives and trade-o?s for this project and how you might employ a weighting method to assist with this task.

2. How might use of a SWOT analysis play a role?

3. What role might benchmarking play?

4. Assume that the network for this project is provided in Figure on the second page. Also assume that it is not possible to accomplish tasks A, D, and E any faster than the durations provided in the on the second page. What other data would be needed in order to determine if project crashing can occur?Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

5. If we now add in the assumption that activity D and activity F require the same person (resource), then we are faced with an example of resource leveling. Either D or F must be delayed. How would we determine which resource leveling option is preferred?

FIGURE: Network for Electronic Medical Records Implementation Implementing Electronic Health Records at St. Hampton’s Hospital Essay Paper

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