Gui Xinning, Chen Yunan, Zhou Xiaomu, Reynolds Tera L, Zheng Kai, Hanauer David A
College of Information Sciences and Technology, Pennsylvania State University, University Park, Pennsylvania, USA.
Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA.
JAMIA Open. 2020 Jan 7;3(1):53-61. doi: 10.1093/jamiaopen/ooz051. eCollection 2020 Apr.
Physician champions are "boots on the ground" physician leaders who facilitate the implementation of, and transition to, new health information technology (HIT) systems within an organization. They are commonly cited as key personnel in HIT implementations, yet little research has focused on their practices and perspectives.
We addressed this research gap through a qualitative study of physician champions that aimed to capture their challenges and strategies during a large-scale HIT implementation. Email interviews were conducted with 45 physician champions from diverse clinical areas 5 months after a new electronic health record (EHR) system went live in a large academic medical center. We adopted a grounded theory approach to analyze the data.
Our physician champion participants reported multiple challenges, including insufficient training, limited at-the-elbow support, unreliable communication with leadership and the EHR vendor, as well as flawed system design. To overcome these challenges, physician champions developed their own personalized training programs in a simulated context or in the live environment, sought and obtained more at-the-elbow support both internally and externally, and adapted their departmental sociotechnical context to make the system work better.
This study identified the challenges physician champions faced and the strategies they developed to overcome these challenges. Our findings suggest factors that are crucial to the successful involvement of physician champions in HIT implementations, including the availability of instrumental (eg, reward for efforts), emotional (eg, mechanisms for expressing frustrations), and peer support; ongoing engagement with the champions; and appropriate training and customization planning.
医师倡导者是“实地作战”的医师领导者，他们推动组织内新的健康信息技术（HIT）系统的实施及向该系统的过渡。他们通常被视为HIT实施中的关键人员，但很少有研究关注他们的实践和观点。
我们通过对医师倡导者的定性研究填补了这一研究空白，该研究旨在了解他们在大规模HIT实施过程中面临的挑战和采取的策略。在一个大型学术医疗中心新的电子健康记录（EHR）系统上线5个月后，我们对来自不同临床领域的45位医师倡导者进行了电子邮件访谈。我们采用扎根理论方法分析数据。
我们的医师倡导者参与者报告了多个挑战，包括培训不足、即时支持有限、与领导层及EHR供应商的沟通不可靠以及系统设计存在缺陷。为克服这些挑战，医师倡导者在模拟环境或实际环境中制定了自己的个性化培训计划，在内部和外部寻求并获得了更多即时支持，并调整了部门的社会技术环境以使系统运行得更好。
本研究确定了医师倡导者面临的挑战以及他们为克服这些挑战而制定的策略。我们的研究结果表明了对医师倡导者成功参与HIT实施至关重要的因素，包括工具性支持（如对努力的奖励）、情感支持（如表达挫败感的机制）和同伴支持的可用性；与倡导者的持续互动；以及适当的培训和定制计划。
