Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
Int J Med Inform. 2020 Dec;144:104281. doi: 10.1016/j.ijmedinf.2020.104281. Epub 2020 Sep 23.
To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts.
Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders.
A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel.
Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing.
Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.
总结文献综述的结果，以确定和探讨影响电子健康记录（EHR）在不同医疗保健环境中实施成功的关键因素。
尽管电子健康记录（EHR）具有广泛认可的益处，但由于实施过程的原因，它们的全部潜力并未得到充分发挥。随着越来越多的国家推出国家 EHR 计划，与主要利益相关者分享最新和最相关的国际经验至关重要。
与来自爱尔兰的多学科知识使用者和专家组成的多学科小组合作，进行了快速伞式综述。在几个搜索引擎（PubMed、CINAHL、Scopus、Embase、Web of Science、IEEE Xplore、ACM Digital Library、ProQuest、Cochrane）和灰色文献中完成了全面的文献综述。符合入选标准的确定研究（n=5040）经过分析、审查、讨论和专家小组解释，确定了障碍和促进因素。
确定了 27 篇文献综述，这些综述根据不同背景下的各种利益相关者的观点，捕捉到了成功实施 EHR 的关键组织、人力和技术因素。尽管医疗保健环境的规模、类型和文化影响了组织因素，但每个因素都被认为对 EHR 成功至关重要；治理、领导力和文化、终端用户参与、培训、支持、资源和工作流程。除了组织差异外，个人终端用户具有不同的技能和特点、感知收益和激励因素，以及对健康生态系统的感知变化，这些对成功也至关重要。最后，EHR 技术的成功取决于可用性、互操作性、适应性、基础设施、法规、标准和政策以及测试。
15 个相互关联的组织、人力和技术因素被确定为在初级、二级和长期护理环境中成功实施 EHR 的重要因素。在确定如何利用这些因素时，还必须考虑当地环境、个人终端用户和不断发展的技术。
