Davis Selena
Health Information Science, University Victoria, Victoria, BC, Canada.
Front Digit Health. 2020 Nov 20;2:575951. doi: 10.3389/fdgth.2020.575951. eCollection 2020.
Personal health records designed for shared decision making (SDM) have the potential to engage patients and provide opportunities for positive health outcomes. Given the limited number of published interventions that become normal practice, this preimplementation evaluation of an integrated SDM personal health record system (e-PHR) was underpinned by Normalization Process Theory (NPT). The theory provides a framework to analyze cognitive and behavioral mechanisms known to influence implementation success. A mixed-methods investigation was utilized to explain the work required to implement e-PHR and its potential to integrate into practice. Patients, care providers, and electronic health record (EHR) and clinical leaders ( = 27) offered a rich explanation of the implementation work. Reliability tests of the NPT-based instrument negated the use of scores for two of the four mechanisms. Participants indicated that e-PHR made sense as explained by two qualitative themes: game-changing technology and sensibility of change. Participants appraised e-PHR as explained by two themes: reflecting on value and monitoring and adapting. The combined qualitative and quantitative results for the other two NPT mechanisms corroborated. Participants strongly agreed (score = 4.6/5) with processes requiring an investment in commitment, explained by two themes: sharing ownership of the work and enabling involvement. Weak agreement (score = 3.6/5) was observed with processes requiring an investment in effort, explained by one theme: uncovering the challenge of building collective action, and three subthemes: assessing fit, adapting to change together, and investing in the change. Finally, participants strongly agreed (score = 4.5/5) that e-PHR would positively affect engagement in self-management decision-making in two themes: care is efficient, and care is patient-centered. Overall, successful integration of e-PHR will only be attained when systemic effort is invested to enact it. Additional investigation is needed to explore the collective action gaps to inform priorities and approaches for future implementation success. This research has implications for patients, care providers, EHR vendors, and the healthcare system for improving the effectiveness and efficiency of patient-centric services. Findings confirm the usefulness of NPT for planning and understanding implementation success of PHRs.
为共同决策（SDM）设计的个人健康记录有潜力让患者参与其中，并为实现积极的健康结果提供机会。鉴于成为常规做法的已发表干预措施数量有限，这种对综合SDM个人健康记录系统（电子个人健康记录）的实施前评估以规范化过程理论（NPT）为基础。该理论提供了一个框架，用于分析已知会影响实施成功的认知和行为机制。采用了混合方法调查来解释实施电子个人健康记录所需的工作及其融入实践的潜力。患者、护理提供者、电子健康记录（EHR）和临床领导者（=27）对实施工作进行了丰富的解释。基于NPT的工具的可靠性测试否定了对四个机制中的两个机制使用分数。参与者表示，电子个人健康记录是有意义的，这可以通过两个定性主题来解释：变革性技术和变革的合理性。参与者对电子个人健康记录的评价可以通过两个主题来解释：反思价值以及监测和调整。其他两个NPT机制的定性和定量结果相互印证。参与者强烈同意（得分=4.6/5）那些需要投入承诺的过程，这可以通过两个主题来解释：共享工作所有权和促进参与。对于那些需要投入努力的过程，观察到的同意程度较弱（得分=3.6/5），这可以通过一个主题来解释：发现建立集体行动的挑战，以及三个子主题：评估适应性、共同适应变化以及为变革投入。最后，参与者强烈同意（得分=4.5/5）电子个人健康记录将在两个主题方面对自我管理决策的参与产生积极影响：护理高效，且护理以患者为中心。总体而言，只有当投入系统性努力来实施电子个人健康记录时，才能实现其成功整合。需要进行额外的调查，以探索集体行动差距，为未来实施成功的优先事项和方法提供信息。这项研究对患者、护理提供者、电子健康记录供应商以及医疗保健系统改善以患者为中心的服务的有效性和效率具有启示意义。研究结果证实了NPT在规划和理解个人健康记录实施成功方面的有用性。
