07- working with health it systems - unit 9 - potential issues with adoption and installation of an...

8/12/2019 07- Working with Health IT Systems - Unit 9 - Potential Issues with Adoption and Installation of an HIT System

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Working with Health IT Systems

Potential Issues with Adoption andInstallation of an HIT System

This material (Comp7_Unit9) was developed by Johns Hopkins University, funded by the Department of Health and Human

Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC00013.


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Learning Objectives

Identify frequently encountered challenges to

adoption and implementation of HIT systems.

Propose solutions to common problems in theimplementation of HIT systems.

Design a plan to address

barriers to implementation

of an HIT system.

2Health IT Workforce Curriculum

Version 3.0/Spring 2012


Potential Issues with Adoption and Installation

of an HIT System


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Why Do Systems Fail?

Systems can get in the way. Is it useable?

Lack of the story metaphor Narratives are essential to a patient's episode of

illness. Poor communication is more often detrimental topatients than lack of knowledge.

Computers should enable clinicians to capturenarratives easily.

The structure of the patient's record stronglyinfluences the ease of information retrieval.

(Walsh, 2004)





of an HIT System


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Understanding CriticalSuccess Factors

User Characteristics

Cognitive style, personality, demographics, situational

variables, attitudes, expectations

System Design Characteristics

Hard/software performance, learning,

decision-support, usability, GUI

Organizational Characteristics

organization culture, top level

support, commitment





of an HIT System


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Common Challenges to Adoption &Integration of HIT

Hard to enter data

Free textisnt

Structured text

Tough on the front end

Easier on the back end

Reading

40% slower online

If the computer is used to generate output, the layout

structure of the reports are important as this can influence

clinical decisions in sometimes fundamental ways. (Walsh, 2004)5

Health IT Workforce Curriculum


Working with Health IT SystemsPotential Issues with Adoption and Installation

of an HIT System


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Effect of Presentation Order Primacy Effect

A: Diabetic Medication X

This medication is effective; it lowers sugar

levels. It makes one feel better and boostsenergy. It may cause nausea and headache.

B: Diabetic Medication YThis medication may cause headache andnausea. It boosts energy and makes one feelbetter. It is effective; it lowers sugar levels.

(Neto, Chen and Chan, 2002)




of an HIT System


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The Three Ts




of an HIT System


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Intervention Strategies




of an HIT System


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ToolKits

AHRQ Emerging Lessons Toolkit:

http://healthit.ahrq.gov/portal/server.pt/community/ahrq-

funded_projects/654/emerging_lessons/11227

AAFP: HIT in the Small Office Online Tutorials

http://www.centerforhit.org/online/chit/home/cme-learn/tutorials.html

Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medicalrecords by physicians from systematic review to taxonomy and

interventions. BMC Health Serv Res. 2010; 10: 231. Available from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334/

HIMSS FlyerGetting Started With An EHR

http://www.himss.org/content/files/GettingStartedEMR_Flyer1.pdf

ACP: EHR Adoption Road Map and Tools http://www.acponline.org/running_practice/technology/ehr/roadmap/

HRSA Implementation Tool Kit

http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdop

tiontoolbox/

10Health IT Workforce CurriculumVersion 3.0/Spring 2012


of an HIT System
http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334/http://www.himss.org/content/files/GettingStartedEMR_Flyer1.pdfhttp://www.himss.org/content/files/GettingStartedEMR_Flyer1.pdfhttp://www.acponline.org/running_practice/technology/ehr/roadmap/http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/http://www.hrsa.gov/publichealth/business/healthit/toolbox/HealthITAdoptiontoolbox/http://www.acponline.org/running_practice/technology/ehr/roadmap/http://www.himss.org/content/files/GettingStartedEMR_Flyer1.pdfhttp://www.himss.org/content/files/GettingStartedEMR_Flyer1.pdfhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924334/http://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://www.centerforhit.org/online/chit/home/cme-learn/tutorials.htmlhttp://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq-funded_projects/654/emerging_lessons/11227


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Summary

Why do systems fail?

Critical success factors

Challenges to adoption and integration The three Ts

Toolkits for your use



of an HIT System


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References

References

Adler, K. How to Successfully Navigate Your EHR Implementation; Family Practice Management. 2007 February.

Available from: http://www.aafp.org/fpm/2007/0200/p33.html

Bartos, C., Bulter, B., Penrod, L., Fridsma, D., Crowley, R. Negative CPOE Attitudes Correlate with Diminished

Power in the Workplace. AMIA Annu Symp Proc 2008; 2008: 36-40. Available from:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655973/

Neto, A., Chen, T. & Chan J. Order effect" in the provision of medication information. MJA 2002; 176 (8): 401-4020

Psychiatric News; May 7, 2010 ; Volume 45 Number 9 Page 6; from the American Psychiatric Association.

Available from: http://psychnews.psychiatryonline.org/issues.aspx?journalid=61

Trivedi, M., Daly, E., Kern. J., et al. Barriers to implementation of a computerized decision support system for

depression: an observational report on lessons learned in "real world" clinical settings. BMC Medial Informatics

and Decision Making 2009. Available from: http://www.biomedcentral.com/1472-6947/9/6

Walsh, S. The clinician's perspective on electronic health records and how they can affect patient care. BMJ 2004

May 15: 328(7449): 1184-1187. Available from:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC411103/?tool=pmcentrez



of an HIT System
http://www.aafp.org/fpm/2007/0200/p33.htmlhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655973/http://psychnews.psychiatryonline.org/issues.aspx?journalid=61http://www.biomedcentral.com/1472-6947/9/6http://www.ncbi.nlm.nih.gov/pmc/articles/PMC411103/?tool=pmcentrezhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC411103/?tool=pmcentrezhttp://www.biomedcentral.com/1472-6947/9/6http://www.biomedcentral.com/1472-6947/9/6http://www.biomedcentral.com/1472-6947/9/6http://psychnews.psychiatryonline.org/issues.aspx?journalid=61http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655973/http://www.aafp.org/fpm/2007/0200/p33.html


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ReferencesCharts, Tables, Figures

9.1 Adler, K. How to Successfully Navigate Your EHR Implementation; Family Practice Management. 2007 February.

Available from: http://www.aafp.org/fpm/2007/0200/p33.html

9.2 Boonstra, A., Broekhusis, M. Barriers to the acceptance of electronic medical records by physicians from systematic

review to taxonomy and interventions. BMC Health Services Research2010, 10:231 .Available from:

http://www.biomedcentral.com/1472-6963/10/231

Images Slide 2: Girl Flexing Muscles. Courtesy Dr. Patricia Abbott

Slide 4: Beauty and the Beast. Available from:

http://www.flickr.com/photos/e_phots/2646616379/sizes/m/in/photostream/

Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0)

Slide 5: Shop Sign. Courtesy Dr. Patricia Abbott.

Slide 6: Pills. Available from:

http://www.flickr.com/photos/silverlinedwinnebago/1405216080/sizes/m/in/photostream/

Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0) SilverlinedWinnebago. Slide 7: Lion. Available from: http://upload.wikimedia.org/wikipedia/commons/4/40/Just_one_lion.jpg

GNU Free Documentation License



f HIT S t
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