McAlearney Ann Scheck, Hefner Jennifer L, Sieck Cynthia, Rizer Milisa, Huerta Timothy R
Department of Family Medicine, College of Medicine, Ohio State University, United States; Division of Health Services Management and Policy, College of Public Health, Ohio State University, United States; Department of Corporate Strategy and Innovation, École Polytechnique Fédérale de Lausanne, Switzerland.
Department of Family Medicine, College of Medicine, Ohio State University, United States.
Int J Med Inform. 2014 Jul;83(7):484-94. doi: 10.1016/j.ijmedinf.2014.04.002. Epub 2014 Apr 28.
While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies.
We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes.
We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation.
Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.
虽然电子健康记录（EHR）系统有推动医疗保健改善的潜力，但大多数EHR实施都未达预期。实施中的不足往往是由于实施过程中的组织问题而非技术问题。信息技术和医疗管理文献中的证据可用于提高实施成功的可能性，但将这些证据转化为实践的情况并不普遍。我们的目标是全面研究和综合医疗保健组织中管理门诊EHR系统实施的最佳实践，突出适用的管理理论和成功策略。
我们对美国六个医疗保健组织的关键信息提供者进行了45次访谈，这些组织是根据门诊EHR实施的报道成功情况有目的地挑选出来的。我们还进行了六个由37名医生组成的焦点小组讨论。使用演绎法和归纳法对访谈和焦点小组记录进行分析，以回答研究问题并探索新出现的主题。
我们认为，门诊EHR实施的成功管理可以由计划-执行-研究-行动（PDSA）质量改进（QI）模型来指导。虽然参与者没有承认也没有强调使用这个模型，但我们发现有证据表明成功的实施实践可以用PDSA模型来构建。此外，成功的站点有三个共同策略：1）使用强调实施促进因素的已发表健康信息技术（HIT）文献中的证据；2）关注工作流程；3）纳入促进实施的关键管理因素。
寻求改善门诊EHR实施过程的组织可以使用PDSA QI模型等框架来指导工作，并提供一种随着时间推移正式纳入新证据的方法。通过PDSA模型实施正式的管理策略并纳入新证据是循证管理的关键要素，也是组织在实施和使用挑战加剧之前主动应对这些挑战的关键方式。
