Perception of Nurses in a Federal and State-Owned Hospital in Nigeria Toward Electronic Health Record Integration.

Despite the potential of using Electronic Health Record (EHR) in hospitals for enhancing the quality of patient care and safety, it has been shown that the implementation of EHRs is low. Much research has focused on the clinical healthcare professionals’ perceptions of EHRs, but little is known about hospital managers. The hospital manager is in a position to serve as an agent for change in implementing EHR technology. The managers are pivotal in leading the implementation of the systems changes required to successfully implement EHRs and thus their perceptions and methodologies. This thesis focuses on hospital managers working in the secondary and tertiary care hospitals managed by the Ministry of Health (MOH) in Saudi Arabia. It examines the current status of EHR implementation and hospital manager perceptions’ of the introducing of integrated EHRs in Saudi Arabia public hospitals. Also, challenges facing hospital managers prior to the implementation of EHRs and their need to implement EHR successfully are addressed. A descriptive design, using a collective cross-sectional quantitative census survey was used to address the research questions. The survey was developed from the literature comprising a self-administered postal questionnaire. Saturation survey sampling was used to achieve completed questionnaires from each of the MOH hospital managers in Saudi Arabia. The questionnaires were distributed to all hospital managers working in MOH hospitals. A total of 220 hospital managers participated, of these 163 completed the questionnaires, representing a 74% response rate which contained complete information on key variables of sufficient validity to be included in subsequent analysis. An open-ended question was also included in the survey where hospital managers were asked to provide dialogue on their experience with EHR. The results show that none of the public hospital had fully implemented EHR and only third of the hospitals had partially implemented EHR. In addition, 41.1% of the hospital managers were not familiar with the concept of EHR and 73.6% had not used the EHR system. The Saudi Arabia hospital managers had a positive attitude towards the introduction of EHR, but were over confident in dealing with resistance from hospital staff. Moreover, the majority of respondents believed that current information technology IT infrastructures did not support the EHR implementation and also hospital staff were not prepared. Financial resources and unclear EHR implementation process model were identified as the most significant barriers to implement EHR in their hospitals. The primary facilitators to support the implementation of EHR were adequate EHR infrastructures, customising training and education program in health informatics, financial support and information on change management implementation. Since hospital managers are the core individuals in each hospital, this study has highlighted the significance of considering the hospital managers’ perception when implementing EHR. The findings may serve as a guiding tool for hospital managers that have not implemented EHR as well as for the MOH in Saudi Arabia.

e13619 Background: NSCLC treatment guidelines recommend comprehensive NGS testing to detect genomic alterations and gene expression in key biomarkers that are relevant in diagnosis, therapy selection, prognosis, and clinical trials. While 70% of patients with NSCLC will have biomarker alterations related to therapeutic options, a large minority of patients still do not receive biomarker testing. Clinical workflow challenges outside the EHR ecosystem, like paper requisitions and faxed results, have been cited as barriers to adoption. To reduce sequencing barriers, Tempus deploys NGS through direct result EHR connection. To evaluate whether integrating comprehensive NGS ordering and resulting into the EHR would improve testing rates, we retrospectively analyzed NSCLC NGS orders from 29 clinical networks which represent over 1500 medical oncologists, before and after EHR integration. Methods: Clinical networks that partnered with Tempus to perform an NGS EHR integration were identified. Only networks with at least 6 months of pre- and post-integration unique patient NGS orders were included. De-identified patient information from these sites were obtained from the Tempus laboratory information management system. NSCLC diagnosis was determined through ICD9/10 codes. NGS tests ordered were limited to xT/xR (solid tumor DNA and RNA), xE (solid tumor whole exome), or xF (circulating tumor DNA). Aggregate unique patients with orders were summated on a per site basis. Descriptive statistics were used to characterize the findings. Results: From May 2019 to July 2023, 29 clinical cancer networks (48% academic medical center, 45% regional health system) that underwent a Tempus NGS EHR integration were identified. Of the 29 networks considered, 3 were excluded due to insufficient data. Of the evaluable 26 networks, Epic EHR was used in the majority (24 of 26). In aggregate, a total of 1825 NSCLC patients were sequenced pre-integration as compared to 2796 patients sequenced post-integration, representing a 53% increase. Academic medical centers experienced a higher increase versus regional health systems (65% v 48%). When examined on a per network basis, the median and mean increase in NSCLC patients sequenced were 49% and 118%, respectively. Conclusions: In this retrospective analysis, Tempus EHR integrations increased ordering of comprehensive NSCLC NGS by 53%. Despite study limitations such as the incomplete resolution into internal alternate sequencing workflows, this large-scale analysis provides further evidence that EHR-based workflow improvements reduce the barrier to appropriate sequencing.

The American Recovery and Reinvestment Act of 2009 accelerated the implementation of electronic health records (EHRs) in pediatric offices. We sought to determine the prevalence and functionalities of EHRs, as well as pediatricians' perceptions of EHRs. An 8-page self-administered questionnaire was sent randomly to 1621 nonretired US members of the American Academy of Pediatrics from July to December 2012. Responses were compared with a similar survey in 2009. The percent of pediatricians, who are using EHRs, increased significantly from 58% in the 2009 survey to 79% in 2012. Only 31% used an EHR considered to have basic functionality, and only 14% used a fully functional EHR. Providers with equal or greater than 20% public insurance patients (threshold for meaningful use eligibility) were more likely to have an EHR. Solo/2-physician practices were least likely to have adopted an EHR. Younger physicians were more likely to consider an EHR important to quality care and perceived the presence of an EHR as more important in recruiting. The number of office-based pediatricians who are using an EHR has steadily risen to almost 80%. EHR cost and reduction in productivity remain serious concerns. Despite the widespread adoption of EHRs by pediatricians, only few use a basic or fully functional EHR and even fewer have added pediatric functionality. There is a role for the EHR certification process to advance functionalities used by pediatricians and to increase efficiency, data exchange capability, and general EHR functionality.

Trends in Use of Electronic Health Records in Pediatric Office Settings

PurposeThe purpose of this paper is to further adaptive structuration theory (AST) by associating technological appropriations with health information technology workarounds. The author argues that appropriating electronic health record (EHR) technology ironically – in a way other than it is designed to be used – and divergently across an organization results in enhanced perceptions of EHR technology and its implementation.Design/methodology/approachData were collected from 345 healthcare employees in a single healthcare organization that was switching to EHRs from paper records. Two major constructs of AST – unfaithfulness and dissension in appropriation – were operationalized and analyzed using multivariate regressions to test the relationship between the type of appropriation and perceptions of EHR technology’s relative advantage and implementation success.FindingsResults reveal that both ironic (unfaithful) technological appropriation and dissension in technological appropriation across the organization predicted employees’ perceptions of EHR’s relative advantage and perceptions of EHR implementation success. Furthermore, physicians are the least likely to perceive EHR’s relative advantage or EHR implementation success. These results exemplify that EHR workarounds are taking place and reaffirm AST’s principle that employees evolve technology to better suit their working environments and preferences.Originality/valueThe survey and scales used in this study further demonstrate that there are meaningful statistical measures to accompany the qualitative methods frequently used in the AST literature. In addition, this paper expands AST research by exploring the positive outcomes that follow ironic and divergent technology appropriations.

Electronic Health Record (EHR) implementation in healthcare facilities is intended to assist with clinicians’ activities, such as evidence based decision making, streamlining providers’ workflow via efficient coordination of patient care. However, there have been mixed findings about clinicians’ perceptions of EHR. While several clinicians agree that EHR improves the quality and efficiency of care, others perceive that EHR interrupts the routine workflows, increases documentation load, and takes away clinicians’ time from patients. This study aims to explore the lived experiences of clinicians who regularly use EHR, to assess the role of EHR in improving quality and safety of healthcare. A qualitative study design based on the grounded theory approach was used. Different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) were interviewed using a semi structured interview. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals. After examining 652 quotes and phrases, 10 major domains emerged. Our study found mixed results, which are consistent with extant literature. Overall, the participants confirmed that EHR improves patient safety by offering reminders, notifications, and alerts. Some respondents found training to be superficial, and of insufficient duration. Participants also thought that EHR can be an interference in clinical activities especially when different EHRs in a multi-system hospital are not integrated well. Some respondents indicated concern about the associated long term costs, including the dependence on technologies and the need to keep up with evolving technologies. Future qualitative and mixed method studies can delve into further exploration of clinicians’ lived experiences as it pertains to specific advantages and disadvantages of EHR.

Purpose:There have been mixed findings of clinicians’ perceptions of ElectronicHealth Record (EHR). This study aims to explore the lived experiences ofclinicians, to assess the role of EHR in improving the quality and safety ofhealthcare.Basic Procedures:A qualitative study design was used. We collected the opinions from differentgroups of clinicians (physicians, hospitalists, nurse practitioners, nurses,and patient safety officers) using semi-structured interviews. Organizationsrepresented were trauma hospitals, academic medical centers, medicalclinics, home health centers, and small hospitals.Main findings:Our study found clinicians’ ambivalent assessments toward EHR, which confirmsextant literature. We compared the responses by job roles and found thatnurses were positive about improving efficiency with EHR while othersregarded EHR as time-consuming. While many underscored the importance of EHRin avoiding medical errors by improving data accessibility, nurses hadconcerns regarding data accuracy. Interoperability appeared to be a concerngiven limited system integration.Principal conclusions:Lived experiences of clinicians further tease out the mixed views about theeffectiveness of EHR and highlight the challenges in EHR implementation.Redesigning the EHR and improving its implementation process may bepotential solutions to increase its effectiveness.

ObjectivesTo evaluate implementation of digital National Early Warning Score 2 (NEWS2) in a cardiac care setting and a general hospital setting in the COVID-19 pandemic.DesignThematic analysis of qualitative semistructured interviews...

Background and Objectives: The American Recovery and Reinvestment Act of 2009 accelerated the implementation of electronic health records (EHRs) in pediatric offices. We determined the prevalence and functionalities of EHRs, as well as pediatricians' perceptions of EHRs. Methods: An 8-page self-administered questionnaire was sent to 1,619 randomly selected non-retired US …

BackgroundMedical consortiums take the integration of electronic health records (EHR) as a breakthrough point and the construction of an integrated medical service system as the ultimate goal. However, their establishment has disrupted the balance between the original medical order and interest patterns. While promoting active cooperation among hospitals, it has also intensified active competition between them.ObjectiveThis study aimed to explore the internal evolution mechanism of the co-opetition strategies adopted by the superior and subordinate hospitals in the medical consortiums, providing a theoretical foundation and policy reference for achieving EHR integration.MethodsOn the basis of analyzing the structure of the main players in the co-opetition game and their game motivations, we established an evolutionary game model, analyzed the impact mechanism of key parameters, simulated the dynamic evolution process of the co-opetition strategies using MATLAB (MathWorks), and finally proposed actionable policy recommendations.ResultsThe results indicate that three factors positively promote EHR integration: (1) EHR complementarity, (2) hospitals’ willingness and ability to use EHR, and (3) the average revenue per unit of EHR. Conversely, the investment cost per unit of resources hinders EHR integration. Neither the original income of hospitals nor the stock of EHR significantly affects the evolution direction of the game system.ConclusionsMedical consortiums should actively involve all levels and different types of medical institutions, and continuously improve hospitals’ willingness and ability to use EHR through training, assistance, support, and sinking of medical resources, etc. The government should establish a reward and punishment system, optimize the operation and supervision mechanism of medical consortiums, and monitor and punish opportunism behaviors such as “free-riding.” It is also crucial to strengthen the construction of hospital informatization infrastructure and improve the technical, content, and sharing standards for EHR construction. In addition, designing reward and punishment mechanisms as well as cost accounting based on “unit EHR resources” is also of great significance for promoting the EHR integration.

BackgroundThe United States is facing an opioid overdose epidemic resulting in an unprecedented number of preventable deaths. The use of medications including buprenorphine and methadone has proven effective for opioid use disorder (OUD), but many patients struggle to stay in treatment. Novel solutions, such as digital health tools, offer one option to help improve clinic management and improve treatment engagement.ObjectiveUsing a mixed methods approach, we investigated facilitators and barriers to the use of a third-party digital health platform called Opioid Addiction Recovery Support (OARS) to aid OUD treatment engagement and adherence in a primary care setting.MethodsPatient and provider use of OARS was observed for 10 months and summarized using descriptive statistics. Differences in use were assessed using Wilcoxon signed rank tests. Additionally, key informant interviews were conducted with providers who prescribe medication for opioid use disorder (MOUD) and their case managers to understand the facilitators and barriers to implementation. Qualitative data were analyzed using a coding reliability thematic analysis approach.ResultsAmong 205 patients invited to use OARS, the median age was 37 (IQR 31-44) years, 130 (63.4%) identified as men, and 193 (94.1%) identified as non-Hispanic White. Of these 205 patients, 158 (77.1%) used the app at least 1 time. The median number of days the 158 patients viewed test results was 1 (IQR 1‐3), progress was 1 (IQR 0‐2), and educational content was 0 (IQR 0‐1). The 55 patients whose providers had manually entered their results into OARS when the electronic health record (EHR) integration failed viewed test results (P=.002), progress (P<.001), and educational content (P<.001) more days than the 103 patients who could not view their results in OARS. Providers and the lead case manager reported that OARS increased patient-provider communication, allowed patients to better track their overall MOUD treatment, and enhanced providers’ ability to identify patients at risk for relapse. They also acknowledged that the lack of integration between OARS with the EHR resulted in administrative burdens, which impacted provider use of the system.ConclusionsFindings from this study highlight the challenges of successfully implementing OARS with patients who receive MOUD in primary care settings. Our results show a lack of OARS uptake among providers, case managers, and patients, despite positive assessments made by participants. We also show several barriers that impacted provider use, including the lack of integration between OARS and EHR. Future research is needed (1) to determine whether digital health tools like OARS are efficacious in improving OUD outcomes and, if proved efficacious, (2) to identify ways to routinize the use of digital health tools in MOUD treatment, primarily by solving technical and organizational challenges associated with EHR integration and patient engagement.

Background: The integration of Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) has revolutionized healthcare by enabling digital storage, exchange, and management of patient information. This abstract explores the landscape of EMR acceptance and adoption through a bibliometric analysis of research literature indexed in Scopus from January 2014 to December 2023. The study identified 138 relevant articles focusing on EMR and EHR acceptance, employing tools like VOSviewer and Rstudio-Biblioshiny for data visualization and analysis. Method: This study is qualitative research with a literature study approach. The data collection technique in this study used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and obtained 138 documents for analysis. This dataset is converted to CSV format for further processing in Mapchart, VosViewer, and Rstudio-Biblioshiny for thorough analysis. Result: Key findings reveal a predominant focus on factors influencing EMR adoption, including technological infrastructure, user training, and regulatory mandates. The United States and Canada emerged as leading contributors to EMR research, highlighting their advanced healthcare systems. Theoretical frameworks such as the Technology Acceptance Model (TAM) and Unified Theory of Acceptance and Use of Technology (UTAUT) were frequently employed to assess adoption determinants. Conclusions: The study identifies gaps in research, particularly in areas such as cybersecurity and user satisfaction, suggesting future avenues for investigation. By addressing these gaps, researchers can enhance the usability and effectiveness of EMR and EHR systems, thereby improving healthcare delivery and patient outcomes globally.

This study collects survey data (n = 345) from a healthcare organization in the early stages of electronic health record (EHR) implementation to understand how a series of organizational communication sources—managers, coworkers, IT personnel, and online organizational sources—impact healthcare employees’ (a) EHR resistance and (b) perceptions of EHR’s relative advantage. Regression results reveal that the levels of EHR information employees sought from coworkers did not predict EHR resistance or perceived relative advantage. Seeking information from managerial sources enhances EHR’s perceived relative advantage and decreases affective EHR resistance but is not related to behavioral or cognitive EHR resistance. Seeking information from IT staff decreased all types of EHR resistance and increased EHR’s perceived relative advantage. Finally, seeking information from online organizational sources increased EHR’s perceived relative advantage and decreased behavioral and cognitive resistance but is not related to affective EHR resistance. Study implications and limitations are offered.

To audit and present the relationship and requirement for incorporating EMR, EHR and PHR data, by featuring its utilization and esteem difficulties and dangers. Electronic Medical Records (EMR) and Electronic Health Records (EHR) are utilized by doctors to enhance nature of care and contain costs. Though EMR is generally viewed as an interior hierarchical framework, the EHR is characterized as a between authoritative framework. As of late, a modernized stage for understanding focused medicinal care known as Personal wellbeing records (PHR) was presented, as an empowering influence for self-administration of medicinal records. PHRs are online frameworks utilized by patients. Their straightforwardness of data should prompt better educated and locked in patients. PHR, EMR and EHR can live on various stages under different advancements and benchmarks. In spite of the fact that EMR contains nearby data and gives quick and precise conveyance, the major preferred standpoint of EHR in therapeutic practice is the accessibility of cross-supplier restorative data. Persistent focused wellbeing activities, for example, PHR empower the combination of the prime data parts in the EMR and the EHR frameworks. This incorporation of restorative data consolidates statistic, way of life and behavioral information with wellbeing records, in this manner furnishing a thorough view that corresponds with the meaning of patient-focused therapeutic care. It can prompt an emotional enhancement in customized mind and also general wellbeing basic leadership, bringing about enhanced wellbeing and health, yet additionally postures genuine difficulties and dangers to security and protection.

How clinicians utilize medically actionable genomic information, displayed in the electronic health record (EHR), in medical decision-making remains unknown. Participating sites of the Electronic Medical Records and Genomics (eMERGE) Network have invested resources into EHR integration efforts to enable the display of genetic testing data across heterogeneous EHR systems. To assess clinicians’ engagement with unsolicited EHR-integrated genetic test results of eMERGE participants within a large tertiary care academic medical center, we analyzed automatically generated EHR access log data. We found that clinicians viewed only 1% of all the eMERGE genetic test results integrated in the EHR. Using a cluster analysis, we also identified different user traits associated with varying degrees of engagement with the EHR-integrated genomic data. These data contribute important empirical knowledge about clinicians limited and brief engagements with unsolicited EHR-integrated genetic test results of eMERGE participants. Appreciation for user-specific roles provide additional context for why certain users were more or less engaged with the unsolicited results. This study highlights opportunities to use EHR log data as a performance metric to more precisely inform ongoing EHR-integration efforts and decisions about the allocation of informatics resources in genomic research.