eHealth and Organizational Change in Hospital Setting a Case Study on Electronic Health Records (original) (raw)
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Studies in health technology and informatics, 2012
The historical National Programme for Information Technology (NPfIT) in England was the most expensive (~$20billion) and ambitious politically-driven IT-based transformations of public services ever undertaken. Nationwide implementation of integrated electronic health record (EHR) systems in hospitals was at the heart of the NPfIT (~$10billion). We conducted the first longitudinal, prospective, and sociotechnical case study-based evaluations of the implementation and adoption of national EHRs implementations in 12 'early adopter' hospitals across England. This paper reports the arrival, implementation process, and stakeholders' experiences of one EHR software (Millennium) at a National Health Service's (NHS) general hospital participating in NPfIT, hereafter called Alpha. From the outset, Alpha envisioned the implementation of EHR as a practice of change management to improve its performance. This vision attributed to the establishment of a 'design authority' at Alpha, including users from various capacities and levels. The 'design authority' was perceived a key contributor to appropriate (compared to other hospitals we studied) clinical engagement and bottom-up approach to deploying EHR. Through conducting several hundreds of group and individual workflow familiarization, Alpha adopted a novel approach to training staff on EHR software. This led to greater local configuration and high sense of ownership among users, which transformed work practices towards overall better performance of the hospital. Contrary to painful and turbulent experiences of EHR implementation via NPfIT route in the English hospitals, this in-depth case study revealed the importance of vision (change management) and insightful leadership in 'working out' EHR. We advocate envisioning EHRs as change management endeavors to enhance their complex, multi-dimensional, and sociotechnical adoption in healthcare settings.
Studies in health technology and informatics, 2015
The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for th...
eHealth key issues in Portuguese Public Hospitals
2012 25th IEEE International Symposium on Computer-Based Medical Systems (CBMS), 2012
Hospital managers, health and IT Professionals have their work increasingly supported and dependent on information systems and technologies. To be more effective and efficient in the way health care is delivered, considerable improvements in health information systems and technologies still have to be made at the local and national levels. This is a study that seeks for a deeper understanding of the Portuguese hospitals main stakeholder's concerns regarding their interaction with Information Technology, so opportunities for improvement can be later identified. Seven public hospitals have been selected to participate in this study. In each hospital, managers, IT and health professional were interviewed leading to the discussion of some global and shared perceptions that resulted in a list of eHealth key issues in public Portuguese hospitals.
Advances in Library and Information Science
Hospitals are complex to operate, particularly in the implementation of electronic health records systems. The implementation and use of electronic health records (EHR) management in hospitals requires management to reinforce change and sustain results for good end results. The purpose of this chapter is to unveil tools used by public and private hospital management to reinforce change and sustain results in the implementation of electronic health records systems. Both public and private hospital are based in the eThekwini Municipality. The conceptual framework based on Kotter Leading Change Model was comprehensively discussed. The findings of the study revealed that there are no standard guidelines for both public and private hospitals in the implementation of EHR system in hospitals. Clarity regarding change management policies and procedures in the implementation of EHR system in both public and private hospitals is required. The study recommends that both public and private hosp...
Managing Change of EHR Systems
2019
This article analyzes the associations between four leadership styles, the implementation of renewed Electronic Health Record (EHR) systems in hospitals and performance. The four leadership styles are taken from the literature on change management and are: mobilize, guide, involve and adapt. The performance measure is inspired by the Technology Acceptance Model (TAM). The empirical context is the implementation of a new EHR system in a Danish multi-site hospital in 2015. We apply a mixed-method approach combining qualitative and quantitative data. Using a Structural Equation Model (SEM) combined with focus group interviews we find evidence for significant impact on performance of all four leadership styles.
Case study analysis of the challenges faced with implementation of EHR system
2016
Implementation of the electronic health record (EHR) among hospitals has increased substantially within the recent years, but concerns still remain regarding the unique challenges that hospitals face in adopting and achieving meaningful use (MU) of EHRs. EHR implementation initiatives tend to be driven by the promise of enhanced integration and availability of patient information, which can improve efficiency and cost-effectiveness, through changing the physician-patient relationship into a shared care team approach to deal with the rapidly changing environment. The challenges in implementing a system wide EHR system mainly include a range of factors from the organizational and technological standpoint such as organizational structure, human skills, culture, technical infrastructure, financial restraints and synchronization. This essay is a case study analysis of a real time EHR implementation to identify the challenges and increase understanding of the technical and behavioral mana...
Technologic: Conceptualising Health Care Transformation With the Electronic Patient Record
Systems, Signs, and Action 2(1): 41-59.
In Denmark, as elsewhere, electronic patient records are being presented as the solution to a multitude of problems in health care. However, in spite of these promises, the practical development and implementation of EPRs have consistently run into problems. I present material based on field studies in a Danish region, which have been working hard to develop and implement a standardized EPR. Meanwhile involved people have also been contemplating how the introduction of this new technology may affect hospital organization and work routines. Although development and implementation have run into a variety of problems, the ways of analyzing and reacting to these problems remain remarkably similar. I propose that patterns of envisioning and working with the EPR follow a techno-logic, which enables involved actors to imagine technical benefits of the new technologies while downplaying non-technical issues in developing and using them. This understanding constructs a persistent enigma of organization, because it is blind to the continuous intertwinements in practice between the technical and the organizational, the material and the discursive; or, between systems, signs, and action.
Health Communication, 2017
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation-from both formal and informal sources-is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR's perceived relative advantage.
2019
What types of organizational value do information technologies such as Electronic Health Records (EHRs) create in hospitals? Building on results from multi-site empirical research, this paper explores this issue in the case of the French EHR. Considering, on the basis of a theory of “management tools”, the organizational changes induced by the implementation of EHR, it suggests that the organizational transformation expected by public decision makers is only starting. At the same time, it argues that an enriched conceptualization of the notion of “organizational value” could make it possible to identify and manage some weak signals differently, thus indicating that on-going collective learning is likely to reconfigure practices and work processes. Departing from a dominant view focused on the improvement of care quality, security and efficiency, this article thus contributes to enriching the notion of the “organizational value” of information technologies in hospitals. Key-words org...