This document summarizes research on the implementation of electronic medical records (EMRs) in hospitals. It begins with an introduction on the challenges of EMR implementation and a literature review identifying factors that help or hinder successful implementation. It then describes two case studies of EMR implementation: a US hospital that converted from paper to an EMR system, and a Swedish hospital that integrated multiple older EMR systems into one new system. Interviews at the Swedish hospital found the implementation went well, with time savings and improved information, though some personnel time was diverted from clinical work. The US implementation faced significant delays and problems that halted progress.
Operations research within UK healthcare: A reviewHarender Singh
The paper "Operations research within UK healthcare: a review" provides an overview of the application of operations research (OR) in the UK healthcare sector. The review highlights the contribution of OR in improving efficiency, reducing costs, and enhancing patient outcomes in various areas of healthcare, such as hospital management, patient flow, resource allocation, and scheduling. The paper also discusses the challenges and opportunities in applying OR in healthcare, such as data availability, ethical considerations, and stakeholder engagement. Overall, the review provides insights into the potential of OR to drive innovation and improve healthcare delivery in the UK.
Recommendations on Evidence Needed to Support Measurement Equivalence between...CRF Health
Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment
as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biologic
agents, and devices was underscored by the release of the US Food and Drug Administration’s draft
guidance for industry titled "Patient-Reported Outcome Measures: Use in Medical Product Development
to Support Labeling Claims." The intent of the guidance was to describe how the FDA will evaluate the
appropriateness and adequacy of PRO measures used as effectiveness endpoints in clinical trials. In
response to the expressed need of ISPOR members for further clarification of several aspects of the draft
guidance, ISPOR’s Health Science Policy Council created three task forces, one of which was charged
with addressing the implications of the draft guidance for the collection of PRO data using electronic data
capture modes of administration (ePRO). The objective of this report is to present recommendations from
ISPOR’s ePRO Good Research Practices Task Force regarding the evidence necessary to support the
comparability, or measurement equivalence, of ePROs to the paper-based PRO measures from which
they were adapted.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
This document summarizes a systematic review that identified key challenges and barriers to implementing the patient-centered medical home (PCMH) model based on 28 studies from the United States. The review found six main challenges: 1) difficulties transforming practice operations and managing change, 2) implementing functional electronic health records, 3) inadequate funding and payment models, 4) insufficient practice resources and infrastructure, 5) variations in PCMH standards and accreditation, and 6) limitations in performance measures. The review concludes that understanding these challenges is important for Australian health reforms considering adopting PCMH elements.
Automated Extraction Of Reported Statistical Analyses Towards A Logical Repr...Nat Rice
This document describes research on developing an automated system to extract key information from clinical trial literature, such as the hypothesis, sample size, statistical tests used, and conclusions. The system maps extracted phrases to relevant knowledge sources. It was trained and tested on 42 full-text articles about chemotherapy for non-small cell lung cancer, achieving a precision of 86%, recall of 78%, and F-score of 0.82 for classifying sentences. The goal is to utilize this extracted information for quality assessment, meta-analysis, and disease modeling.
Six sigma dmaic methodology as a support tool for health technology assessmen...Murilo Souza, MBA, MBB
This document describes a study that uses a Six Sigma DMAIC methodology to support a health technology assessment of two antibiotics - Ceftriaxone and Cefazolin plus Clindamycin. The goal is to assess the clinical and organizational impact of each antibiotic in terms of postoperative length of stay for patients undergoing tongue cancer surgery. The DMAIC cycle is applied to analyze the process and compare the antibiotics, with length of stay used as the performance measure. Multiple linear regression analysis is also used within the DMAIC cycle to add additional information and confirm results. The findings show the methodology is effective for determining the impact of each antibiotic and guiding decision making.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
This document summarizes a presentation given by Peter Embi on clinical and translational research and informatics literature from 2012-2013. It begins with Embi's background and approach to identifying relevant papers. It then describes the topics covered in the presentation, which are grouped into categories like clinical data reuse, data management/discovery, researcher support/resources, and recruitment. For each category, 1-2 key papers are summarized in 1-3 sentences. The summaries highlight the papers' goals, methods, and conclusions. The document concludes by mentioning other notable papers and events from the past year.
Presentation for UP MSHI HI201 Health Informatics class under Dr. Iris Tan and Dr. Mike Muin. Check out my blog - http://jdonsoriano.wordpress.com/2014/10/09/fitting-the-pi…making-it-work/
Operations research within UK healthcare: A reviewHarender Singh
The paper "Operations research within UK healthcare: a review" provides an overview of the application of operations research (OR) in the UK healthcare sector. The review highlights the contribution of OR in improving efficiency, reducing costs, and enhancing patient outcomes in various areas of healthcare, such as hospital management, patient flow, resource allocation, and scheduling. The paper also discusses the challenges and opportunities in applying OR in healthcare, such as data availability, ethical considerations, and stakeholder engagement. Overall, the review provides insights into the potential of OR to drive innovation and improve healthcare delivery in the UK.
Recommendations on Evidence Needed to Support Measurement Equivalence between...CRF Health
Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment
as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biologic
agents, and devices was underscored by the release of the US Food and Drug Administration’s draft
guidance for industry titled "Patient-Reported Outcome Measures: Use in Medical Product Development
to Support Labeling Claims." The intent of the guidance was to describe how the FDA will evaluate the
appropriateness and adequacy of PRO measures used as effectiveness endpoints in clinical trials. In
response to the expressed need of ISPOR members for further clarification of several aspects of the draft
guidance, ISPOR’s Health Science Policy Council created three task forces, one of which was charged
with addressing the implications of the draft guidance for the collection of PRO data using electronic data
capture modes of administration (ePRO). The objective of this report is to present recommendations from
ISPOR’s ePRO Good Research Practices Task Force regarding the evidence necessary to support the
comparability, or measurement equivalence, of ePROs to the paper-based PRO measures from which
they were adapted.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
This document summarizes a systematic review that identified key challenges and barriers to implementing the patient-centered medical home (PCMH) model based on 28 studies from the United States. The review found six main challenges: 1) difficulties transforming practice operations and managing change, 2) implementing functional electronic health records, 3) inadequate funding and payment models, 4) insufficient practice resources and infrastructure, 5) variations in PCMH standards and accreditation, and 6) limitations in performance measures. The review concludes that understanding these challenges is important for Australian health reforms considering adopting PCMH elements.
Automated Extraction Of Reported Statistical Analyses Towards A Logical Repr...Nat Rice
This document describes research on developing an automated system to extract key information from clinical trial literature, such as the hypothesis, sample size, statistical tests used, and conclusions. The system maps extracted phrases to relevant knowledge sources. It was trained and tested on 42 full-text articles about chemotherapy for non-small cell lung cancer, achieving a precision of 86%, recall of 78%, and F-score of 0.82 for classifying sentences. The goal is to utilize this extracted information for quality assessment, meta-analysis, and disease modeling.
Six sigma dmaic methodology as a support tool for health technology assessmen...Murilo Souza, MBA, MBB
This document describes a study that uses a Six Sigma DMAIC methodology to support a health technology assessment of two antibiotics - Ceftriaxone and Cefazolin plus Clindamycin. The goal is to assess the clinical and organizational impact of each antibiotic in terms of postoperative length of stay for patients undergoing tongue cancer surgery. The DMAIC cycle is applied to analyze the process and compare the antibiotics, with length of stay used as the performance measure. Multiple linear regression analysis is also used within the DMAIC cycle to add additional information and confirm results. The findings show the methodology is effective for determining the impact of each antibiotic and guiding decision making.
College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
In the early-to-mid 1990’s, bench top analyzers entered the clinical laboratory scene. These analyzers were much smaller than the conventional analyzers being used, and utilized touch-screen PCs for ease of use. For this reason, they were able to be used closer to the patient’s bedside or outside of the laboratory environment. However, at this point in time, laboratory testing results were stored within the device and would have to then be sent to the main central laboratory for analysis.
Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
This document summarizes a presentation given by Peter Embi on clinical and translational research and informatics literature from 2012-2013. It begins with Embi's background and approach to identifying relevant papers. It then describes the topics covered in the presentation, which are grouped into categories like clinical data reuse, data management/discovery, researcher support/resources, and recruitment. For each category, 1-2 key papers are summarized in 1-3 sentences. The summaries highlight the papers' goals, methods, and conclusions. The document concludes by mentioning other notable papers and events from the past year.
Presentation for UP MSHI HI201 Health Informatics class under Dr. Iris Tan and Dr. Mike Muin. Check out my blog - http://jdonsoriano.wordpress.com/2014/10/09/fitting-the-pi…making-it-work/
Exploring the Impact of Information System IntroductionSuelette Dreyfus
This document summarizes a study that explored the impact of introducing an information system at an Australian hospital emergency department. The study conducted a 9-month longitudinal case study at a major trauma center that recently introduced a large-scale IS. Through observations and interviews, the study identified both positive and negative consequences of the IS introduction on key work routines. The findings provide insights for both research and practice on understanding the impacts of implementing new information systems in healthcare settings.
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
NUR3165 SFCC Statewide Study to Assess Nurses Experience Review Article.docxstirlingvwriters
The document summarizes a statewide study conducted in Texas to evaluate nurses' satisfaction with electronic health records (EHRs). Over 1,000 nurses responded to an online survey that assessed EHR usability and meaningful use using the Clinical Information System Implementation Evaluation Scale and a Meaningful Use Maturity-Sensitive Index. Results showed that EHR maturity levels and nurse age significantly influence satisfaction. Qualitative analysis of open-ended responses provided further insight into nurses' experiences. Recommendations will inform strategies to improve EHR satisfaction.
Structure and development of a clinical decision support system: application ...komalicarol
Clinical decision requires to infer great, diverse and not suitably
organized quantity of information and having low time to decide.
The therapeutic choice is fundamental to formulate a strategy to
avoid complications and to achieve favorable results, being more
important in some specialties. In addition, medical decision-makers are overloaded with clinical tasks, have an intense work rate and
are subject to a great demand, and are prone to greater tiredness.
In this sense, computer tools can be extremely useful, as can deal
with a lot of information in much less time than decision-makers.
Thus, the existence of a tool that assists them in decision-making
is of crucial importance
Physicians' use of clinical practice guidelines (CPGs) remains insufficient despite dissemination efforts. This study examined factors affecting CPG use among resident physicians in Japan. A survey of 535 residents at 61 hospitals found that a physician's habitual CPG use, CPG-related education, and the combination of an individual's digital preference and a hospital's superior IT infrastructure were associated with more frequent CPG use. Specifically, physicians who received CPG education worked at hospitals with better IT systems and access to databases. Their CPG use was also more likely to involve electronic resources. The study aims to identify effective strategies for promoting CPG implementation by clarifying how individual and organizational factors interact.
Physicians' use of clinical practice guidelines (CPGs) remains insufficient despite dissemination efforts. This study examined factors affecting CPG use among resident physicians in Japan. A survey of 535 residents at 61 hospitals found that a physician's habitual CPG use, CPG-related education, and the combination of an individual's digital preference and a hospital's superior IT infrastructure were associated with more frequent CPG use. Specifically, physicians who received CPG education worked at hospitals with better IT systems and access to databases. Their CPG use was also more likely to involve electronic resources. Having a habit of using CPGs for patient care strongly predicted their frequent use. Improving physicians' behaviors, education, and the interface of individual
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
This document summarizes a study that developed a goal programming algorithm to schedule 11 nurses across a two-week period at a hospital. The goals were to satisfy each nurse's contracted time, ensure minimum nurse requirements by role each day, give full-time nurses a weekend off while avoiding more than two consecutive days off, and honor nurses' weekend preference when possible. The algorithm solved the 154-variable, 120-constraint scheduling problem in under 30 seconds. The results showed schedules that met goals for minimum nurse levels each day and individual nurses' two-week schedules.
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
Application Of Statistical Process Control In Manufacturing Company To Unders...Martha Brown
This document describes a systematic review of 57 studies on the application of statistical process control (SPC) in healthcare quality improvement. The review found that SPC was applied in a wide range of healthcare settings and specialties using 97 different variables. Benefits identified included helping various stakeholders manage change and improve processes. Limitations included the complexity of correctly applying SPC. Barriers were things like lack of staff training, while factors facilitating use included leadership support and data feedback. Overall, SPC was found to be a versatile tool for quality improvement when applied appropriately.
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
Many molecules in nature have geometry, which enables
them to exist as non-superimposable mirror images, or enantiomers.
Modulation of toxicity of such molecules provides
possibility for therapeutics, since they target
multiple points in biochemical pathways. It was hypothesized
that toxicity of a chemical agent, could be counteracted
by a homeopathic preparation of the enantiomer of
the chemical agent
A Qualitative Study to Understand the Barriers and Enablers in implementing a...Vojislav Valcic MBA
The document summarizes a qualitative study that explored barriers and enablers to implementing an Enhanced Recovery After Surgery (ERAS) program across several hospitals affiliated with the University of Toronto. Semistructured interviews were conducted with surgeons, anesthesiologists, and nurses. The interviews identified several common barriers, including lack of resources, poor communication, resistance to change, and patient factors. However, interviewees generally supported implementing a standardized ERAS program with guidelines based on evidence, education of staff and patients, and standardized order sets. Identifying these barriers and enablers is an important first step to successfully adopting an ERAS program.
826 Unertl et al., Describing and Modeling WorkflowResearch .docxevonnehoggarth79783
826 Unertl et al., Describing and Modeling Workflow
Research Paper �
Describing and Modeling Workflow and Information Flow in
Chronic Disease Care
KIM M. UNERTL, MS, MATTHEW B. WEINGER, MD, KEVIN B. JOHNSON, MD, MS,
NANCY M. LORENZI, PHD, MA, MLS
A b s t r a c t Objectives: The goal of the study was to develop an in-depth understanding of work practices,
workflow, and information flow in chronic disease care, to facilitate development of context-appropriate
informatics tools.
Design: The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease
care. The authors iteratively collected data using direct observation and semi-structured interviews.
Measurements: The authors observed all aspects of care in three different chronic disease clinics for over 150
hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes,
and technology. Observation data were analyzed through an open coding approach. The authors then developed
models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The
authors also conducted nine semi-structured interviews to confirm and refine the models.
Results: The study had three primary outcomes: models of workflow for each clinic, models of information flow
for each clinic, and an in-depth description of work practices and the role of health information technology (HIT)
in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease
providers.
Conclusions: In response to the analysis of workflow and information flow, the authors developed ten guidelines
for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to
design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow
and information flow in HIT design and implementation.
� J Am Med Inform Assoc. 2009;16:826 – 836. DOI 10.1197/jamia.M3000.
Introduction
Health information technology (HIT) can enhance efficiency,
increase patient safety, and improve patient outcomes.1,2
However, features of HIT intended to improve patient care
can lead to rejection of HIT,3 or can produce unexpected
negative consequences or unsafe workarounds if poorly
aligned with workflow.4,5
More than 90 million people in the United States, or 30% of
the population, have chronic diseases.6 HIT can assist with
longitudinal management of chronic disease by, for exam-
Affiliations of the authors: Department of Biomedical Informatics
(KMU, MBW, KBJ, NML), Center for Perioperative Research in
Quality (KMU, MBW, KBJ), Institute of Medicine and Public Health,
VA Tennessee Valley Healthcare System and the Departments of
Anesthesiology and Medical Education (MBW), Department of
Pediatrics (KBJ), Vanderbilt University, Nashville, TN.
This research was supported by a National Library of Medicine
Training Grant, Number T15 .
This document discusses the debate between randomized clinical trials (RCTs) and observational studies using big data. While RCTs are better for minimizing bias, observational studies can include more patients and answer questions RCTs cannot. The document outlines several large cancer databases that can help learn from every patient, including SEER and NCDB registries. It describes how these databases are being enriched with additional data sources like EHRs, genomic data, and mobile devices. This evolving use of big data from numerous sources can improve outcomes by better understanding toxicity, costs, and quality of cancer care.
The poem "My Heart Leaps Up" by William Wordsworth discusses the speaker's deep love and connection to nature. In just 9 lines, Wordsworth conveys how the speaker's heart fills with joy at the sight of nature, like a child's would. Though an adult, the speaker has maintained the sense of wonder, curiosity, and lightness of being from his childhood in the presence of nature. The simple poem expresses how nature allows the speaker's heart and spirit to leap with delight like they did when he was a young boy experiencing the natural world.
Top Rated Paper Writing Services. 90 Best Essay Writing Service IdeasMichelle Singh
This document discusses a study on the impact of indoor environmental quality on worker productivity. The study surveyed workers in several office buildings. It found that crowded workspaces, job dissatisfaction, and poor physical environments were the main factors negatively affecting productivity. Issues like thermal problems, poor ventilation, and crowded spaces were common complaints. The results suggest productivity could be improved by 4-10% by enhancing indoor environmental quality through measures like improved ventilation and thermal comfort.
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Exploring the Impact of Information System IntroductionSuelette Dreyfus
This document summarizes a study that explored the impact of introducing an information system at an Australian hospital emergency department. The study conducted a 9-month longitudinal case study at a major trauma center that recently introduced a large-scale IS. Through observations and interviews, the study identified both positive and negative consequences of the IS introduction on key work routines. The findings provide insights for both research and practice on understanding the impacts of implementing new information systems in healthcare settings.
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
NUR3165 SFCC Statewide Study to Assess Nurses Experience Review Article.docxstirlingvwriters
The document summarizes a statewide study conducted in Texas to evaluate nurses' satisfaction with electronic health records (EHRs). Over 1,000 nurses responded to an online survey that assessed EHR usability and meaningful use using the Clinical Information System Implementation Evaluation Scale and a Meaningful Use Maturity-Sensitive Index. Results showed that EHR maturity levels and nurse age significantly influence satisfaction. Qualitative analysis of open-ended responses provided further insight into nurses' experiences. Recommendations will inform strategies to improve EHR satisfaction.
Structure and development of a clinical decision support system: application ...komalicarol
Clinical decision requires to infer great, diverse and not suitably
organized quantity of information and having low time to decide.
The therapeutic choice is fundamental to formulate a strategy to
avoid complications and to achieve favorable results, being more
important in some specialties. In addition, medical decision-makers are overloaded with clinical tasks, have an intense work rate and
are subject to a great demand, and are prone to greater tiredness.
In this sense, computer tools can be extremely useful, as can deal
with a lot of information in much less time than decision-makers.
Thus, the existence of a tool that assists them in decision-making
is of crucial importance
Physicians' use of clinical practice guidelines (CPGs) remains insufficient despite dissemination efforts. This study examined factors affecting CPG use among resident physicians in Japan. A survey of 535 residents at 61 hospitals found that a physician's habitual CPG use, CPG-related education, and the combination of an individual's digital preference and a hospital's superior IT infrastructure were associated with more frequent CPG use. Specifically, physicians who received CPG education worked at hospitals with better IT systems and access to databases. Their CPG use was also more likely to involve electronic resources. The study aims to identify effective strategies for promoting CPG implementation by clarifying how individual and organizational factors interact.
Physicians' use of clinical practice guidelines (CPGs) remains insufficient despite dissemination efforts. This study examined factors affecting CPG use among resident physicians in Japan. A survey of 535 residents at 61 hospitals found that a physician's habitual CPG use, CPG-related education, and the combination of an individual's digital preference and a hospital's superior IT infrastructure were associated with more frequent CPG use. Specifically, physicians who received CPG education worked at hospitals with better IT systems and access to databases. Their CPG use was also more likely to involve electronic resources. Having a habit of using CPGs for patient care strongly predicted their frequent use. Improving physicians' behaviors, education, and the interface of individual
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
This document summarizes a study that developed a goal programming algorithm to schedule 11 nurses across a two-week period at a hospital. The goals were to satisfy each nurse's contracted time, ensure minimum nurse requirements by role each day, give full-time nurses a weekend off while avoiding more than two consecutive days off, and honor nurses' weekend preference when possible. The algorithm solved the 154-variable, 120-constraint scheduling problem in under 30 seconds. The results showed schedules that met goals for minimum nurse levels each day and individual nurses' two-week schedules.
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
The document discusses challenges in transforming healthcare systems and applying systems engineering approaches. It notes that while the US leads in medical advances, gaps remain in translating research into practice. Systems transformation requires integrating changes across multiple levels, sustaining gains over time, and spreading successful redesigns. Implementation science provides frameworks to study how research gets applied in real-world settings. Strategies include incorporating user needs, using data for decision making, and taking account of past implementation studies to promote evidence-based quality improvement.
Application Of Statistical Process Control In Manufacturing Company To Unders...Martha Brown
This document describes a systematic review of 57 studies on the application of statistical process control (SPC) in healthcare quality improvement. The review found that SPC was applied in a wide range of healthcare settings and specialties using 97 different variables. Benefits identified included helping various stakeholders manage change and improve processes. Limitations included the complexity of correctly applying SPC. Barriers were things like lack of staff training, while factors facilitating use included leadership support and data feedback. Overall, SPC was found to be a versatile tool for quality improvement when applied appropriately.
BioMed CentralBMC Health Services ResearchssOpen AcceDebChantellPantoja184
BioMed CentralBMC Health Services Research
ss
Open AcceDebate
From theory to practice: improving the impact of health services
research
Kevin Brazil*1, Elizabeth Ozer2, Michelle M Cloutier3, Robert Levine4 and
Daniel Stryer5
Address: 1Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University and St. Joseph's Health System
Research Network, Hamilton, ON, Canada, 2Department of Pediatrics/Adolescent Medicine, University of California, San Francisco, CA, USA,
3Department of Pediatrics, University of Connecticut Health Center and Connecticut. Children's Medical Center, Hartford, CT, USA,
4Occupational and Preventive Medicine, Meharry Medical College, Nashville, TN, USA and 5Center for Outcomes and Effectiveness Research,
Agency for Healthcare Research and Quality, Rockville, MD, USA
Email: Kevin Brazil* - [email protected]; Elizabeth Ozer - [email protected]; Michelle M Cloutier - [email protected];
Robert Levine - [email protected]; Daniel Stryer - [email protected]
* Corresponding author
Abstract
Background: While significant strides have been made in health research, the incorporation of
research evidence into healthcare decision-making has been marginal. The purpose of this paper is
to provide an overview of how the utility of health services research can be improved through the
use of theory. Integrating theory into health services research can improve research methodology
and encourage stronger collaboration with decision-makers.
Discussion: Recognizing the importance of theory calls for new expectations in the practice of
health services research. These include: the formation of interdisciplinary research teams;
broadening the training for those who will practice health services research; and supportive
organizational conditions that promote collaboration between researchers and decision makers.
Further, funding bodies can provide a significant role in guiding and supporting the use of theory in
the practice of health services research.
Summary: Institutions and researchers should incorporate the use of theory if health services
research is to fulfill its potential for improving the delivery of health care.
Background
While significant strides have been made in medical
research over the past several decades, many research
results considered important by researchers and expert
committees are not being used by health care practition-
ers. While the value of health services research must be
judged by its validity, its utility cannot be taken for
granted. There has been an assumption that when
research information is available it will be accessed,
appraised and then applied [1]. However, knowledge of a
research-based recommendation is by itself insufficient to
ensure its adoption. While the value of research evidence
as a basis for decision making in health care is well estab-
lished, the incorporation of such evidence into decision-
making remains inconsistent [2].
The gap betw ...
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.There are a total of thirteen hospitals included in this review. These facilities have implemented vitals capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
IMPACT OF HEALTH INFORMATICS TECHNOLOGY ON THE IMPLEMENTATION OF A MODIFIED E...hiij
The Modified Early Warning System (MEWS) is based on a patient score that helps the medical team
monitor patients to identify a patient that may be experiencing a sudden decline in care. This study consists
of a detailed review of clinical data and patient outcomes to assess impact of technology and patient care.
There are a total of thirteen hospitals included in this review. These facilities have implemented vitals
capture and the MEWS scoring system.
Many molecules in nature have geometry, which enables
them to exist as non-superimposable mirror images, or enantiomers.
Modulation of toxicity of such molecules provides
possibility for therapeutics, since they target
multiple points in biochemical pathways. It was hypothesized
that toxicity of a chemical agent, could be counteracted
by a homeopathic preparation of the enantiomer of
the chemical agent
A Qualitative Study to Understand the Barriers and Enablers in implementing a...Vojislav Valcic MBA
The document summarizes a qualitative study that explored barriers and enablers to implementing an Enhanced Recovery After Surgery (ERAS) program across several hospitals affiliated with the University of Toronto. Semistructured interviews were conducted with surgeons, anesthesiologists, and nurses. The interviews identified several common barriers, including lack of resources, poor communication, resistance to change, and patient factors. However, interviewees generally supported implementing a standardized ERAS program with guidelines based on evidence, education of staff and patients, and standardized order sets. Identifying these barriers and enablers is an important first step to successfully adopting an ERAS program.
826 Unertl et al., Describing and Modeling WorkflowResearch .docxevonnehoggarth79783
826 Unertl et al., Describing and Modeling Workflow
Research Paper �
Describing and Modeling Workflow and Information Flow in
Chronic Disease Care
KIM M. UNERTL, MS, MATTHEW B. WEINGER, MD, KEVIN B. JOHNSON, MD, MS,
NANCY M. LORENZI, PHD, MA, MLS
A b s t r a c t Objectives: The goal of the study was to develop an in-depth understanding of work practices,
workflow, and information flow in chronic disease care, to facilitate development of context-appropriate
informatics tools.
Design: The study was conducted over a 10-month period in three ambulatory clinics providing chronic disease
care. The authors iteratively collected data using direct observation and semi-structured interviews.
Measurements: The authors observed all aspects of care in three different chronic disease clinics for over 150
hours, including 157 patient-provider interactions. Observation focused on interactions among people, processes,
and technology. Observation data were analyzed through an open coding approach. The authors then developed
models of workflow and information flow using Hierarchical Task Analysis and Soft Systems Methodology. The
authors also conducted nine semi-structured interviews to confirm and refine the models.
Results: The study had three primary outcomes: models of workflow for each clinic, models of information flow
for each clinic, and an in-depth description of work practices and the role of health information technology (HIT)
in the clinics. The authors identified gaps between the existing HIT functionality and the needs of chronic disease
providers.
Conclusions: In response to the analysis of workflow and information flow, the authors developed ten guidelines
for design of HIT to support chronic disease care, including recommendations to pursue modular approaches to
design that would support disease-specific needs. The study demonstrates the importance of evaluating workflow
and information flow in HIT design and implementation.
� J Am Med Inform Assoc. 2009;16:826 – 836. DOI 10.1197/jamia.M3000.
Introduction
Health information technology (HIT) can enhance efficiency,
increase patient safety, and improve patient outcomes.1,2
However, features of HIT intended to improve patient care
can lead to rejection of HIT,3 or can produce unexpected
negative consequences or unsafe workarounds if poorly
aligned with workflow.4,5
More than 90 million people in the United States, or 30% of
the population, have chronic diseases.6 HIT can assist with
longitudinal management of chronic disease by, for exam-
Affiliations of the authors: Department of Biomedical Informatics
(KMU, MBW, KBJ, NML), Center for Perioperative Research in
Quality (KMU, MBW, KBJ), Institute of Medicine and Public Health,
VA Tennessee Valley Healthcare System and the Departments of
Anesthesiology and Medical Education (MBW), Department of
Pediatrics (KBJ), Vanderbilt University, Nashville, TN.
This research was supported by a National Library of Medicine
Training Grant, Number T15 .
This document discusses the debate between randomized clinical trials (RCTs) and observational studies using big data. While RCTs are better for minimizing bias, observational studies can include more patients and answer questions RCTs cannot. The document outlines several large cancer databases that can help learn from every patient, including SEER and NCDB registries. It describes how these databases are being enriched with additional data sources like EHRs, genomic data, and mobile devices. This evolving use of big data from numerous sources can improve outcomes by better understanding toxicity, costs, and quality of cancer care.
Similaire à Implementation Of Electronic Medical Records In Hospitals Two Case Studies (20)
The poem "My Heart Leaps Up" by William Wordsworth discusses the speaker's deep love and connection to nature. In just 9 lines, Wordsworth conveys how the speaker's heart fills with joy at the sight of nature, like a child's would. Though an adult, the speaker has maintained the sense of wonder, curiosity, and lightness of being from his childhood in the presence of nature. The simple poem expresses how nature allows the speaker's heart and spirit to leap with delight like they did when he was a young boy experiencing the natural world.
Top Rated Paper Writing Services. 90 Best Essay Writing Service IdeasMichelle Singh
This document discusses a study on the impact of indoor environmental quality on worker productivity. The study surveyed workers in several office buildings. It found that crowded workspaces, job dissatisfaction, and poor physical environments were the main factors negatively affecting productivity. Issues like thermal problems, poor ventilation, and crowded spaces were common complaints. The results suggest productivity could be improved by 4-10% by enhancing indoor environmental quality through measures like improved ventilation and thermal comfort.
Why College Athletes Should Get Paid Essay Example StudyHipMichelle Singh
The document provides instructions for requesting writing assistance from HelpWriting.net, including creating an account, completing an order form with instructions and deadline, reviewing writer bids and choosing one, and authorizing payment upon approval of the completed paper. Revisions are available and plagiarized work will be refunded.
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The document provides instructions for students to get writing help from HelpWriting.net. It outlines a 5 step process: 1) Create an account with valid email and password. 2) Complete a 10 minute order form providing instructions, sources, and deadline. 3) Review bids from writers and choose one based on qualifications. 4) Review the completed paper and authorize payment if satisfied. 5) Request revisions to ensure needs are fully met.
The document discusses the steps a student would take to request an assignment be written for them through the website HelpWriting.net, including registering for an account, providing instructions for the paper in an order form, and choosing a writer to complete the work based on their qualifications and reviews. It also outlines the process of reviewing the completed paper, making revisions if needed, and ensuring high quality original content. The website aims to fully meet students' writing assistance needs through this process.
Download Reflective Essay Example 50 Essay ExampMichelle Singh
The document discusses how discourse communities are found everywhere and influence how humans communicate. It provides the example of the author's experience joining the weightlifting discourse community. Initially, the author was unfamiliar with the specialized terminology and customs. Over time by observing others in the community, especially his father, the author learned the language of weightlifting and considers himself an avid lifelong member of this discourse community.
Pin On Essay On Plagiarism In C. Online assignment writing service.Michelle Singh
The document discusses how the monster Grendel in Beowulf is connected to allusions from the Old Testament books of Genesis and Wisdom, as Grendel is initially presented as a killer with no motivation but allusions to these biblical texts provide more context around his monstrous acts. It analyzes the interconnection between Grendel and the Old Testament through these allusions, showing Christian influences in the text's description of Grendel.
Writing Abstract In A Research Paper - HelpingMichelle Singh
The document discusses diagnosing respiratory distress in neonates. Key signs include abnormal breath sounds, arterial blood gas levels, and chest x-ray findings. Surfactant deficiency is a common cause of respiratory distress, as surfactant helps keep lungs inflated. Surfactant replacement therapy is the standard treatment for respiratory distress syndrome.
001 Why I Need Scholarship Essay. Online assignment writing service.Michelle Singh
The document discusses critical success factors for project success. It introduces Pinto and Slevin's identification of critical success factors as essential elements that must be satisfied if a project is to be successful. These include clear goals and objectives, competent project manager, executive support, adequate funding and realistic schedules. The document states that satisfying these critical success factors enhances the likelihood of project success.
The document provides instructions for visiting Earth as an alien, with rules covering areas like eavesdropping on human transmissions to understand their culture, choosing an inconspicuous "saucer-shaped" vehicle to avoid detection, and avoiding flying over major cities or military areas. It recommends conducting research in remote, sparsely populated places without formal air patrols to reduce the risk of being spotted. The document aims to aid survival by advising aliens on how to blend in and avoid confrontation with humans.
The Best Research Paper Topics. 200 Easy ResearcMichelle Singh
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The Bhagavad Gita depicts Arjuna struggling with an internal conflict over whether to engage in battle against his kin. Arjuna is unsure how to reconcile his duty as a warrior with the violence he must commit. Krishna counsels Arjuna, telling him he should not hesitate to fulfill his duty and that he must fight without attachment to the outcomes of his actions. Krishna explains fundamental Hindu philosophical concepts to help Arjuna overcome his doubts and do his duty.
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Here is a SWOT analysis of IMAX Corporation:
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- Potential to expand into virtual/augmented reality entertainment
- Partnerships with streaming services and virtual theaters during COVID-19 closures
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This document discusses the origins and key teachings of Buddhism. It describes how Siddhartha Gautama founded Buddhism in the 5th century BCE after achieving enlightenment under the Bodhi tree in India. Some of the key events in his life that led to the development of Buddhist doctrine include leaving his wealthy life to seek answers to suffering, meditating extensively, and realizing the Four Noble Truths and Eightfold Path while under the Bodhi tree. The document also briefly outlines the divisions in Buddhism over time and how its teachings have spread worldwide.
This document discusses the stages of team development: forming, storming, norming, and performing. It focuses on the storming stage, where conflicts can arise as team members struggle to define roles and processes. The team is emerging from the storming stage with increased motivation and knowledge. However, new challenges or lingering interpersonal issues could cause the team to revert back to the storming stage. Resolving interpersonal issues is key to fully moving past storming into the norming stage of improved cooperation and productivity. Education on the team development process helps teams navigate the stages more smoothly.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
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This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
Reimagining Your Library Space: How to Increase the Vibes in Your Library No ...Diana Rendina
Librarians are leading the way in creating future-ready citizens – now we need to update our spaces to match. In this session, attendees will get inspiration for transforming their library spaces. You’ll learn how to survey students and patrons, create a focus group, and use design thinking to brainstorm ideas for your space. We’ll discuss budget friendly ways to change your space as well as how to find funding. No matter where you’re at, you’ll find ideas for reimagining your space in this session.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
2. 182 J. Øvretveit et al. / Health Policy 84 (2007) 181–190
patent records by 2005. In 2003, 3% of NHS hospitals
had implemented the policy [1], and by mid 2006 the
EMR implementation date was estimated to be “2007
at the earliest”. Some of the challenges are technical,
but mostly they are professional and political. There are
also large financial and commercial interests at stake,
some of which have national strategic policy impli-
cations. A recent USA review noted that most health
care providers needed more information about how
to implement IT successfully, as well as the limited
researchonthissubject[2].Implementationtheorypro-
vides explanations of why certain actions were taken
to carry out an idea or policy, and of the conditions
which help and hinder the actions. It can sometimes
predict the actions and conditions necessary in a par-
ticular situation to get the results desired from a change.
IT implementation theory in health care is at an early
stage of development, in part because of the few stud-
ies, but also because of the complexity of healthcare,
the many different settings and the types of IT which
are developing at a rapid pace.
The purpose of this paper is to provide evidence
for implementers and policy makers to make more
informed decisions about EMR implementation, and to
contribute to theory of EMR implementation in health-
care. To do this, the paper:
• Provides a description of two implementations; one
of a full conversion from a paper to an EMR sys-
tem (USA), another of an upgrade-integration from
many older different systems to one integrated EMR
system (Sweden);
• Derives an evidence-based theory of EMR imple-
mentation in health care from a review of research,
and by refining the review through comparison to
empirical data from the two case studies.
2. Methods
A review of research was undertaken using a Med-
line search and papers referenced in retrieved studies
whichwerenotshowninthesearch.Tworecentreviews
of research were also used [2,3]. Twenty one papers
were finally selected for a short summary of features
which helped and hindered the implementation and
successful operation of an EMR system.
The empirical research were two case studies of
implementation, using the same methods. One has
already been reported of a conversion in one hospi-
tal and fifteen clinics of one USA Kaiser Permanente
system [4]. The other implementation of an upgrade-
integration in a Swedish teaching hospital is described
below.
The methods and design of the Swedish study was
similar to the US study: a case study with prospec-
tive and concurrent interviews of a selected sample of
thirty informants, halfway through and three months
after implementation. Details of the methods and anal-
ysis are given in the full report and are available
to download from the MMC web site [5] and [6].
The informants were: a project leader, four part-time
project leaders, three personsfrom a supervisorygroup,
four heads of division, seven heads of clinics, one
instructor, five nurses, four doctors and one doctor
secretary. These data were supplemented by hospital
documentation and observation visits. The methods
and questions of the Kaiser case study were replicated
using semi-structured interviews [4–6]. The interviews
were transcribed, coded and collated to create themes.
Unclear responses and contradictory reports were clar-
ified with informants. Themes were only retained when
more than four respondents described the same items.
3. Previous research
Studies of implementation and impact of EMRs are
relatively few, mostly retrospective, without controls,
with most data from informants’ self-reports and often
from surveys. Many of the limited studies are of a few
US health systems which have developed EMRs suited
to their needs over a number of years, which makes
the experience less generalisable. A review of research
was carried out for this study and is summarised below.
It concentrated on the more recent empirical studies of
EMR hospital implementations with the strongest evi-
denceaboutimplementationandaboutwhathelpedand
hindered. The review found that the research spans a
number of years and that many oft-cited studies are
frequently five years or older and do not reflect expe-
rience with some more user-friendly EMR systems
developed in recent years in this fast-moving field.
Even with these review limits, there were large differ-
ences in the settings, implementation processes and the
3. J. Øvretveit et al. / Health Policy 84 (2007) 181–190 183
type of EMR system studied. “Successful implemen-
tation” is defined in different ways, with some studies
not gathering data from multiple stakeholder perspec-
tives, or recognising any process redesign as part of
implementation or as a benefit. Studies define the start,
finish and scope of “implementation” differently, with
some including factors, such as “physician champion”
actions, as part of the intervention and others separating
these as “conditions” which help or hinder implemen-
tation. These differences mean that comparisons and
generalisations need to be made with caution.
This study defines “the intervention” as both the
actions taken to implement the EMR which would not
have otherwise been carried out, and the EMR itself:
how it differs from what was used before [8]. It defines
the conditions or “the context” as the organisational
and wider environmental factors which may help and
hinder implementation [7]. It defines implementation
as actions to select, plan, introduce and achieve “rea-
sonable use” of the new EMR by 90% of the personnel
for 90% of patients intended.
Although the strength of evidence from the better
designed studies selected for review is weak, and gen-
eralisations have low validity, there are a number of
repeatedly reported findings, especially about factors
for successful implementation and which may be used
to guide data gathering. These factors are features of
the EMR system, the implementation process, leader-
ship, resources and the recipient organisation’s culture
[9]. This research can be summarised as a set of factors
which previous research has shown to be important for
different types of EMRs in different settings. This can
be used as a starting point for designing data gather-
ing for research, or for policy-makers or implementers
to assess different systems or implementation plans
(Table 1).
4. Findings from two case studies
Methods and data from the USA Kaiser imple-
mentation have already been reported and will only
be summarised here [4]. This implementation may
be characterised as a “centralised conversion” from a
paper to an electronic medical record. The data from the
Swedish Karolinska hospital implementation, which
were gathered using the same methods, have not been
presented and are given in more detail below. This
Table 1
Initial EMR implementation theory
Factor important for implementation
The EMR system
Ease of navigation, efficiency in use and accessibility
Physician acceptance and implementer’s responsiveness to
concerns
Absence of system failures
No conflicting suitability (managerial/clinical)
Relative advantage (perceived as better)
Compatibility (consistent with values and needs)
Complexity (ease of understanding and use)
Trialability (possibility of experimentation)
Observability (visible examples elsewhere)
Implementation process
User involvement in selection and development
Education provided at the right times, amount and quality
Previous computer or EMR experience
Leadership
Strong management support
Physician champions
Resources
Adequate people and financial resources
Organisation culture and climate
Familiarity with change (“change readiness”)
implementation was a “decentralised integration” of
a number of older EMR systems to one new system.
4.1. Preparation for implementation
In 2003, two 700-bed Stockholm teaching hospi-
tals started a merger to form the Karolinksa University
Hospital (KUS). Interviewees reported that there was
a need to form a common electronic medical record to
increase integration and allow communication between
the two sites, and ultimately, other services. The aims
of the project were to improve patient care and safety,
and save time and costs. The new system would need
to be installed in 40 clinics with 7000 users at the Solna
site, which would need to change the system they used.
Most of the existing hardware could be used, but some
new hardware had to be installed, as well as consid-
erable changes to software. The intervention was not
to “computerise” a paper system, but to change a set
of five old systems to one new system. The new “Take
Care” (TC) system contained patient administration,
clinical medical records, and referral (and replies to
referral information), but it was not an entirely paper-
4. 184 J. Øvretveit et al. / Health Policy 84 (2007) 181–190
less record: there were still many documents such as
EKG and pictures (e.g. radiology). Neither the old or
new systems provided access to guidelines from within
the patient record.
TheUSAKaisercase,bycontrast,wasofconversion
from a paper to an EMR system. Researchers found
a different preparation. The selection decision about
which EMR system to use was made by the Kaiser HQ,
notthecasestudysite.A“CIS”systemwaschosenafter
a reasonably successful small pilot in Colorado. One
hospital and 15 clinics then began implementation in
the Hawaii Kaiser division [4].
4.2. Implementation
At the Karolinska hospital, implementation was
observed and investigated by the researchers over one
year in 2005, and for four months after. In total, approx-
imately 450 persons were actively involved part- or
full-time on the implementation (out of about 7000
employees including physicians).
Once the decision was made in 2004 about which
system to introduce, interviewees reported that senior
leadership made it clear that departments could not
“opt out”, but did have a choice about when they made
the change in the next year and about details of the
video screens. A temporary structure of groups was
established, reporting to senior management. Staffs in
each department were nominated to form a departmen-
tal project group to work with the IT department to
fine-tune the system for their department and carry out
implementation.
The implementation plan built on the plan used to
implement the system at the other hospital site, and to
some extent the much earlier plan for introducing orig-
inal EMRs at the hospital. Changes were introduced in
each of the 40 departments in an overlapping sequence.
The implementation included these interventions to the
hospital and departments:
• Hospital-wide planning and preparation (August–
September 2004), including identifying head of
department and the personnel within their depart-
ment who would play a role in implementation;
• Piloting the system (winter 2004);
• Agreement with head of department about imple-
mentation date, and to establish an implementation
project group (October 2004);
• Departmental implementation: three months for
each department, covering all departments in
2005:
◦ One “instructor” assigned to the department, and
training of a department project group (4 days)
(different dates for different departments);
◦ Hardware and software installation and changes
planned and carried out;
◦ Departmental personnel instruction (varied from
none to 4 h);
◦ Change-over day;
◦ Follow up problem solving and training.
A post implementation phase was planned to
develop the potential of the system, for example to
include order entry (which was part of the old system)
and to develop a more structured record for different
clinics, which would include checklist approaches for
guidelines.
The Kaiser experience was different, in part because
the change from paper to electronic system was more
substantial, and in part because the software was under-
developed and the pilot experience was of limited
relevance to the implementation site. The start was
delayed for 12 months by software problems. After
two years, implementation was 33% complete mainly
because of substantial design and operation problems
and delays. Implementation was then stopped because
of these problems and a new system (“EpicCare”) then
chosen and successfully implemented after a number of
years. The case study findings only covered the three-
year CIS period.
4.3. Impact
An analysis of the interviews carried out halfway
through implementation (June 2005) through to three
months after implementation (March 2006) identified
common themes which are listed below and illustrated
with typical quotes from informants. Approximately
95% of the comments were positive about the imple-
mentation process and the new system.
• Time savings (for example, far fewer telephone calls
as a result of the whole hospital using the same
system);
“Emergency room personnel are very positive as the
new system allows them to follow patients minute
5. J. Øvretveit et al. / Health Policy 84 (2007) 181–190 185
to minute and see which part of the department the
patient is in. This saves work”
• New and better ways to work were being discovered;
“In the emergency room the new system allows a
real-timelistofpatientsinERwithbasicinformation
which doctors easily and quickly see. This is very
useful where two or more doctors are involved with
a patient – before one patient’s information could
have been held on five different systems, many of
which could not be accessed”
• Morecompleteandbetterinformationonthesystem;
• Likely increase in patient safety (e.g. clearer medi-
cation information);
“A lot easier to find patient information. I am certain
it saves time because of this, and improves patient
care because we don’t have to wait to get the infor-
mation from another system”
• Improved integration of the two merged sites;
• Potential for development (e.g. clinics could use
electronic prescriptions and electronic dictation in
the future).
Two categories of negative comments were identi-
fied from the interviews:
• The speed of implementation prevented developing
new procedures;
“People did not get time and help to adjust their
routines to the new system. It would have been much
better to change routines while changing the system.
There was no time for development. Mostly, we just
put what we did on the computer”
• Personnel time was diverted from clinical work
for implementation. (Difficulties getting the time of
physicians and personnel to attend training and help
adapt the system to their department needs).
“Some local project groups had difficulties getting
time for working with TC. Not all head of clinics
and head of units understood that it had to take time
to prepare for TC”
“It was difficult to be able to prepare for TC and at
the same time do the ordinary work”
“Staff had to work overtime to be able to do all that
was expected of them”
These findings contrasted with the findings from
the Kaiser study. Physicians reported lower produc-
tivity, which was also shown by records of changes to
throughput, due to extra time demands entering data,
processing lab result reports, entering orders, and navi-
gating through the system. This created resistance from
the beginning because physicians were only able to get
minor redesign changes and did not believe the assur-
ances that they were given that they would become
faster as they learned how to use the new system. Four-
teen clinicians reported that the CIS demanded an extra
30–75 min per day which persisted even after the initial
learning period, and affected patient care—for exam-
ple, making it difficult to fit in “overload patients”.
The reasons varied: eight respondents thought CIS was
poorly designed and required too many steps; twelve
that the system was cumbersome and not designed
for a range of clinical needs or multiple problems;
and nine reported a lack of clinical capacity to absorb
changes during implementation [4]. The system also
required clarification of clinical roles and responsibil-
ities, which was traumatic for some individuals but
not wholly negative. Resistance and conflict grew but
remained submerged due to a culture which avoided
overt conflict.
4.4. Assessment of necessary conditions for
implementation
Part of the Karolinska case study was to ask infor-
mantswhichfactorsandconditionstheythoughthelped
and which hindered introducing and using the system.
The following were the main factors reported:
4.4.1. Factors helping implementation
• Many were dissatisfied with their previous system
and with having five different medical record sys-
tems in the hospital;
• Personnel were already used to electronic medi-
cal record systems—it was not a change-over from
a paper system, but adjusting to a new EMR
system;
• Personnel saw the benefits of having the same sys-
tem covering two sites (e.g. allowing easy staff and
patient information transfer);
“Once the merger was decided and we could see it
was happening, we were all motivated to get a com-
mon record for all departments and sites: everyone
could see the benefits and necessity for this”
6. 186 J. Øvretveit et al. / Health Policy 84 (2007) 181–190
• The other site was already using the EMR and had
developed it to be user-friendly. The IT department
did not have to make major changes, apart from
increasing the capacity of the system;
• The system had a good reputation and many people
did not like the old systems. The new EMR was said
by users to be a very easy and usable;
“The system itself is intuitive and can be fitted to
the medical work which is done now and also to the
work if it is reorganised”
“This new system saves time because it is quicker to
see where to go for information and to access it”
• The system needed little time-off for training, or to
adjust to it, and little extra work was demanded in
the new system;
• Senior management said the EMR was the highest
priority project and made it so, as did heads of clin-
ics. There was no problem getting resources. The
hospital management group continually pointed out
the importance of the project;
• The project leader was said by many to be very
competent and it was reported that the project was
well planned and organized, in part because of pre-
vious experience of introduction at the other site and
familiarity with the system. A well-functioning local
IT-department in the hospital helped in the imple-
mentation process. They and personnel commented
that there were no problems with the hardware
servers.
4.4.2. Factors which hindered implementation
One interviewee thought that the earlier experience
implementing EMRs in 2000 was a hindrance because,
“it was complicated. It took a lot to learn the new
system, and there were many problems. So our expe-
rience with large IT changes like this was not entirely
positive”.
The merger had happened recently, so new unit
heads were covering both sites and other personnel had
been changed. Some clinics were still reorganising and
this made additional demands on time and a less sta-
ble situation. The time spent by department personnel
on implementation was taken from ordinary work time
and it was sometimes difficult to involve doctors in
the preparation work. There were also some initial dis-
agreements about whether or how much departments
should pay for the system.
“We needed better information about how much time
and money we should have set aside in the department
for this project”.
The education and information for all staff was
reported by two interviewees to be not as good as it
could have been. The short time for implementing the
system hindered the possibility to give all staff bet-
ter preparation. In some teaching groups, there was
reported to be no time for people to ask questions:
“If you had a detailed doctor- or, clinic-specific ques-
tion you did not ask it because there were too many
different people there—secretary nurses etc. and peo-
ple from different clinics.”
For our departmental implementation group we needed
more education in how to work in a project, how to
succeed, necessary conditions and so forth”.
Many interviewees also commented on the very
strong academic culture at the hospital, with national
clinical leaders who had built programmes of excel-
lence and expected a large degree of independence. It
is significant that none of the interviewees commented
on department heads using their power and indepen-
dence for hindering the choice of one system or in
implementation.
In the Kaiser case, the factors reported to help imple-
mentation were:
• A belief that EMR could save time and money and
make possible new research.
• Clearer accountability, and changes to work and
roles.
• Additional “backfill” personnel for an initial period
to reduce impact on workload.
• The later successful implementation of “EpicCare”
was helped by the failure of CIS, as participants had
learned what kind of system they needed.
Those hindering implementation were:
• No participation in selection and little in implemen-
tation.
• System not developed, and required extra time and
work to operate for clinical work.
• Consensus-seeking leaders may have unintention-
ally encouraged opposition and passive resistance.
7. J. Øvretveit et al. / Health Policy 84 (2007) 181–190 187
• No-conflict culture led to feedback and resistance
not being openly expressed or addressed.
5. Discussion
The study shares some of the limitations of much
research into EMR implementation in relying largely
on self-reports by a limited sample of informants. Also,
the analysis does not assess the relative importance of
the different factors in helping or hindering implemen-
tation, or synergies between the factors. The findings
are stronger than some studies because the research
was carried out prospectively and concurrently, drew
on detailed project documentation, and involved a com-
parison between two implementations. The interviews
and case study method made it possible to register other
changes taking place at the same time which may have
helped or hindered implementation: studies often do
not collect or report this “context” information. How-
ever, the limitations mean than the explanations for
the findings and the lessons for other implementations
discussed below need to be treated with caution, and
as suggestive hypotheses rather than as certain con-
clusions. A detailed costing of the project was not
made. In the Karolinska case, there are indications
that the system saved money overall because of the
reports of time saved, but this was not quantified and
costed.
Despite these limitations, there are some conclu-
sions which may be drawn with some degree of
certainty about why the two implementations took the
course they did, and about the lessons for others. One
conclusion is that EMR implementation is a “condi-
tional intervention” and success depends on many prior
and concurrent factors. These conclusions are devel-
oped below by comparing the key findings from the
two case studies, then with those of other studies noted
earlier.
First, Table 2 below summarises key points of com-
parison between the two case studies.
5.1. Comparison to implementation theory
Table 3 summarises evidence from the two studies
about the presence of factors which the review of pre-
vious research showed to be important to successful
implementation.
One reason for the lesser success of the Kaiser
implementation was the more complex change from
paper to EMR. However, the findings provide some
limited evidence of the validity of the earlier research-
based implementation theory. The only two factors
whichwerecommontobothcaseswerestrongmanage-
ment support and adequate resources, but these were
not able to make up for the absence of the other fac-
tors at Kaiser, which were all present in the Karolinska
case: management and resources could not overcome
a poorly designed system and physician opposition.
5.2. “Change capability” as a factor in EMR
implementation
One set of findings from these two cases have
not been reported in previous research. This is that
individual- and organisational- “change capability”
which is proportional the changes under consideration
are important in implementation. Employees have to
adjust cognitively, behaviourally and emotionally to
use a new EMR in everyday work—it affects work
tasks central to their practice [10]. Employees also
experience other changes in their work and surround-
ings due to the constantly changing nature of health
care. The EMR change may exceed people’s capacity
to cope with change, or other changes may combine to
exceed these limits, causing resistance, rejection and
other behaviours by employees trying to continue to
provide an adequate standard of care. The change at
Hawaii Kaiser Permanente from mostly paper to com-
puterdemandedfarmorethanthechangeatKarolinska.
In addition to individual change capability, organ-
isations have different formal systems for managing
change. Some organisations use project teams regu-
larly, have project management systems and personnel
with training and they can be called upon to can lead
or work in change projects: changes can be carried out
using a system and structure which many are famil-
iar with and trained for. Organisations vary in their
development and use of such change management
or learning organisation systems: the Karolinska is a
national centre of excellence and more familiar with
and organised for change than the Kaiser site.
An organisation’s ability to implement an EMR,
however, may be more than the sum of individual
and formal organisational change capability. Features
of the organisation which have been summarised as
8. 188
J.
Øvretveit
et
al.
/
Health
Policy
84
(2007)
181–190
Table 2
Two EMR implementations
Kaiser Karolinska
Type of implementation
change
One hospital and 15 clinics began implementation of one
EMR system (“CIS”) but stopped and changed to
implement another EMR system (EpicCare)
Two-hospital merger led to a change of an existing EMR used
by Karolinska site to the EMR (“TC”) used at the other site.
Implementation successful
System selection “Selection detached from local environment” and made by
USA HQ
Selection local by the hospital
Design and testing Software design and development problems increased local
resistance
Already tried and tested at the other site, but also successfully
piloted locally
Implementation process 12 month start delay due to software problems Selection, planning and full implementation made as planned
and for half the budget
After 2 years implementation 33% complete, stopped and
EpicCare system introduced
Main factors helping
implementation
Belief that EMR could be better for different purposes Consultation before implementation
Clearer accountability, and allowed change to roles which
was mostly positive
Consensus about need for the system and which system was best
Competent IT project leader and team Prioritization and driving by management team
Additional “backfill” personnel provided for an initial
period to reduce impact on workload
Competent IT project leader and team
Tried and tested system
User-friendly intuitive system needing little training
Potential for development of system
Order entry not difficult to integrate
Main factors hindering
implementation
No participation in selection and little in implementation Recent merger not complete with new people in post
System not developed and required extra time and work to
operate for clinical work
Time spent by department personnel on implementation was
taken from ordinary work time
Leaders consensus seeking sometimes encouraged
opposition and passive resistance
Some had difficulties involving doctors in the preparation work
No-conflict culture led to resistance not being openly
expressed or addressed
Initial disagreements about much departments should pay for
the system
Main impact CIS reduced clinicians productivity No extra time burdens and increased efficiency
Better coordination of long term patients reported
9. J. Øvretveit et al. / Health Policy 84 (2007) 181–190 189
Table 3
Presence of factors identified in previous research as important for successful EMR implementation
Factor important for implementation Kaiser Karolinska
The EMR system
Ease of navigation, efficiency in use and
accessibility
No Yes
Physician acceptance and implementer’s
responsiveness to concerns
No Yes
Absence of system failures No Yes
No conflicting suitability (managerial/clinical) No Yes
Relative advantage (perceived as better) Yes (in theory) Yes (in theory)
No (in practice) Yes (in practice)
Compatibility (consistent with values and needs) No (EMR felt by physicians
to be chosen for business
needs not clinical work needs)
Yes
Complexity (ease of understanding and use) No Yes
Trialability (possibility of experimentation) Little (system not fully
developed). Pilot was a
different system and setting
to the implementation site
Yes
Observability (visible examples elsewhere) Yes (in theory). No (in
practice, apart for a few
personnel)
Yes (at the other
hospital site and pilot
department)
Implementation process
User involvement in selection and development No Yes
Education provided at the right times, amount and
quality
Yes Yes
Previous computer or EMR experience Little Yes
Leadership
Strong management support Yes Yes
Physician champion No Yes
Resources
Adequate people and financial resources Yes Yes
Organisation culture and climate
Familiarity with and capacity for change (“change
readiness”)
No Yes
“change readiness” or “change friendly culture” may
enhance individual and organised change capability as
well as being developed by the latter: these include
a climate of optimism about the future, trust in lead-
ership, good interprofessional, interdepartmental and
professional-management relations, shared experience
ofsuccessfullymanagedchanges,andalearningorgan-
isation culture and structures.
Finite change coping capability may also explain
why nearly all EMR implementations “fail to use the
opportunities for process redesign”. All EMR imple-
mentation involve some work redesign, but major
redesign at the same time exceeds the change cop-
ing capacity of most organisations and the tolerance
of most clinicians trying to keep a service running dur-
ing the change. Although it would be more efficient to
“computerise an improved process” it is more realistic
to treat this as a two-stage process, so long as the system
can be easily modified to support new work processes.
6. Conclusions
Many countries have national policies for establish-
ing EMRs and many hospitals are selecting, planning,
implementing or upgrading their systems. There are
10. 190 J. Øvretveit et al. / Health Policy 84 (2007) 181–190
few independent descriptions of implementations, little
research into what helps and hinders, and no research-
based theories of EMR implementation. This paper
derived an EMR implementation theory from the avail-
able research and described implementations in two
case studies. These data provide some limited sup-
port for the theory and also suggest that a previously
unreported factor is important to implementation suc-
cess: “change capability” relative to the EMR and other
changes taking place.
Findings from the two case studies suggest that
EMR implementation is a “conditional intervention”
and success depends on many prior and concurrent
environmental factors. The findings also suggest a con-
cept and hypotheses for future research which are not
reported in earlier studies. The hypothesis is that, the
less change the EMR system demands and the fewer
the other changes which are occurring at the same time,
then the more likely implementation will be success-
ful. The second hypothesis is that four factors may be
amongst those which facilitate effective EMR imple-
mentation: the number and depth of changes demanded
by the EMR and other unrelated concurrent changes;
individuals’ change capacity; the organisations formal
system for managing changes; and a change-ready cul-
ture.
Some of the practical implementation and policy
guidance from the research includes:
• Choose a system which allows a range of needs to
be met, rather than make compromises for a clinical
or a business system, and an EMR which can serve
this system.
• Choose a tried and tested EMR which works for
clinical personnel and saves time. If personnel do
not think it will save time then implementation will
be significantly more difficult and possibly impossi-
ble.
• The system should be easy to modify and develop,
within limits, for different departments and uses.
• The system should be intuitive, requiring little or no
training.
• The decision about the system should be partici-
patory, but once made, implementation should be
directed and driven.
• Forsuccessfulimplementation,balancelocalcontrol
of selection, implementation and clinical participa-
tion with meeting higher-level requirements.
• Involve each level in different ways, with clear and
appropriate parameters about which decisions can
be made locally and which require higher-level deci-
sions about common standards.
• Assess and address the presence and absence of prior
and concurrent factors which have been repeatedly
shown in research to help and hinder implementa-
tion.
Future research is needed for different implemen-
tations of EMRs in different situations, reported in a
standardised way to allow comparisons. Knowledge
on the subject would be improved if studies built on
previous research to test hypotheses, especially about
which conditions are critical for successful operation
and how different parties define this.
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