Barnes Geoffrey D, Sippola Emily, Ranusch Allison, Takamine Linda, Lanham Michael, Dorsch Michael, Sales Anne, Sussman Jeremy
Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA.
Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA.
Implement Sci Commun. 2022 Feb 2;3(1):10. doi: 10.1186/s43058-022-00262-w.
Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation.
Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI sites.
Among 45 interviewees (32 in VA, 13 in MAQI), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI (lower baseline levels, less concern).
The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants.
利用电子健康记录（数字健康）工具促进适当的医疗服务提供的情况日益增多。然而，常用的决定因素框架很少涉及与技术相关实施的关键障碍。
在两种情况下进行了半结构化访谈：一是在实施电子仪表盘（一种人群健康工具）后对国家退伍军人健康事务部（VA）进行访谈，二是在实施类似电子仪表盘之前对密歇根抗凝质量改进倡议（MAQI）进行访谈。该仪表盘旨在供药剂师或护士用于监测医生和其他临床医生安全的门诊抗凝处方。我们进行了快速定性调查分析并选择了实施策略。通过利益相关者焦点小组会议，我们选择了实施策略以解决决定因素并促进在MAQI站点的实施。
在45名受访者（VA中有32名，MAQI中有13名）中，我们确定了实施成功的五个关键决定因素：（1）临床医生的权威和自主权，（2）临床医生的自我认同和工作满意度，（3）文档记录和行政需求，（4）人员配备和工作时间表，以及（5）与现有信息系统的整合。两种情况之间的关键差异包括，MAQI（实施前）而非VA（实施后）对信息技术支持和优先级的担忧，以及VA（基线水平较高，担忧较多）和MAQI（基线水平较低，担忧较少）之间对权威和自主权的担忧有所不同。
电子健康记录工具的成功实施需要有别于其他类型实施的独特考量，必须考虑实施的状态，并且应该解决工具部署对临床工作人员权威和自主权的影响。对实施后和实施前的用户进行访谈能够提供对实施决定因素的全面理解。
