Zharima Campion, Mhlanga Samantha, Abdulla Saira, Goudge Jane, Griffiths Frances
Centre for Health Policy (CHP), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Medical School, University of Warwick, Warwick, UK.
Digit Health. 2024 Nov 3;10:20552076241291286. doi: 10.1177/20552076241291286. eCollection 2024 Jan-Dec.
The study aimed to identify and describe the engagement strategies used in implementing electronic health records in health care settings and to ascertain why they were successful or not, using normalization process theory.
In this rapid review, we searched PubMed and CINAHL for qualitative and mixed methods primary studies published from 2010 to 2023 (June). We identified 41 studies that explored the implementation of EHRs, involving clinicians as participants. For quality appraisal, we employed the standards for reporting qualitative research (SRQR) tool. For analysis, a qualitative comparative analysis, using the normalization process theory was conducted. This was followed by a narrative synthesis to compile and analyze key findings.
About 56% ( = 23) of the studies were conducted in hospitals, while the remaining were done in mental health, maternity, and ambulatory care settings. Participants included a range of clinicians such as nurses, physicians, doctors, dentists, pediatricians and other specialists. Evidence shows that prior to implementation, effective communication of the vision of EHRs and early user involvement in decision-making are useful engagement strategies in preparing users for implementation. Tailored training and on-demand technical support for users sustain system usage during the roll out. Lastly, ongoing engagement with users is essential for continuous user support and system improvements.
User engagement improves the chances of successful implementation, particularly if engagement strategies are effective for the specific stages of implementation. The success of these strategies is more evident when they ensure normalization process theory tenets, which include user coherence, cognitive participation, collective action and reflective monitoring.
本研究旨在利用规范化过程理论，识别和描述在医疗保健环境中实施电子健康记录所采用的参与策略，并确定这些策略成功或失败的原因。
在本次快速综述中，我们在PubMed和CINAHL中搜索了2010年至2023年6月发表的定性和混合方法的原发性研究。我们确定了41项探索电子健康记录实施情况的研究，这些研究将临床医生作为参与者。为了进行质量评估，我们采用了定性研究报告标准（SRQR）工具。在分析方面，我们使用规范化过程理论进行了定性比较分析。随后进行了叙述性综合，以汇总和分析关键发现。
约56%（n = 23）的研究在医院进行，其余研究在心理健康、产科和门诊护理环境中进行。参与者包括一系列临床医生，如护士、内科医生、医生、牙医、儿科医生和其他专科医生。证据表明，在实施之前，有效地传达电子健康记录的愿景以及让早期用户参与决策是让用户为实施做好准备的有用参与策略。为用户提供量身定制的培训和按需技术支持，可在推广过程中维持系统的使用。最后，持续与用户互动对于持续的用户支持和系统改进至关重要。
用户参与可提高成功实施的几率，特别是当参与策略在实施的特定阶段有效时。当这些策略确保规范化过程理论的原则，包括用户连贯性、认知参与、集体行动和反思性监测时，这些策略的成功更为明显。
