Getting IT right: Implementing a maternity EHR
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The document discusses key strategies and methodologies for implementing electronic health records (EHRs) in maternity services, emphasizing a user-centered approach. It identifies benefits such as improved care quality and communication, and highlights success factors including leadership, user engagement, and effective project management. Barriers to implementation are also examined, such as funding issues, skill gaps, and legal concerns, leading to nine recommendations for successful EHR integration.
Getting IT right: Implementing a maternity EHR
- 1. Date: Getting IT Right: A user based approach to implementation of a Maternity Electronic Health Record 11th November 2015 Author: Debra Fenton
- 2. Research question • What do others say are the key strategies for successful implementation of EHRs • Application to acute clinical setting/maternity services • Facilitators and barriers • Building user confidence in IT • Implementation approach • Critical success factors
- 3. Methodology • Literature review (2007-2013) - research, journal articles, personal reviews, commentaries • Thematic analysis • Key words- “Electronic Health Record”, “Electronic Medical Record” or “Clinical Information System” or similar and including “Implementation” and “Barriers”
- 4. Findings • Benefits – Improved quality of care at reduced cost – Continuity of care and improved decision making by having information for clinicians at point of care – Improved communication between health professionals from any location – Clinical care supported by best practice measures, alerts, correct interpretation of written text
- 5. Findings • Elements of success – Leadership – Governance – Project Management – User engagement – Functionality of IT
- 6. Findings • Barriers – Situational barriers – funding, limiting development, past experience with IT, selection process, design and technical concerns, communication with vendor, user engagement – Legal/ethical barriers – liability, privacy issues, clinical autonomy, meets health practitioners legal/ethical practice requirements – Physical/cognitive barriers – skill and aptitude to work with IT – Behavioural barriers – attitudes and opinions
- 7. Theories and Models • Phases and Tasks in EHR implementation (Keshavjee et al., 2003)
- 8. Theories and Models • The FITT framework (Ammenwerth et al., 2006)
- 9. Theories and Models • An Alternative Template Theory of IS Implementation (Lapointe & Rivard, 2007) Organisational (OC) Group (PVIT) Individual (CA) Emergence Use Resistance Routinization
- 10. Application of Findings • Matrix of Influential Concepts for Implementation of EHR Individual Group Organisation Users Perceived usefulness (CA) IT capabilities Support Training Clinical champions Patient interaction User involvement Ownership Empowerment (PVIT) Advisory groups Knowledge mining Multidisciplinary approach Management/support staff Leadership Governance Privacy Security Organisational culture (OC) Readiness Political environment Task/Processes Ease of use (CA) Fit with clinical workflow Point of care documentation Workflow mapping Process redesign Gap analysis/learning needs Workload impact Project management Roles and responsibilities of project team Change management Normalisation (OC) Technology Software design User centric Functionality Fast Input into procurement process, development Vendor relationship Interoperability Compatibility Flexibility
- 11. Application to NZ Maternity Services • Maternity model of care • Organisational culture • Aging workforce • Workforce shortages • Change readiness • Political influences • Key drivers
- 12. User based approach • Shared vision • Bottom up approach • Leadership • Change management • Workflow mapping • Business process re-design • Training and support • Managing increased workload • Impact on woman's care • Woman centre approach • User engagement in project and communication • Functionality of the system
- 14. 9 Recommendations 1. Leadership 2. User engagement/involvement 3. Clinical champions 4. Multidisciplinary approach 5. Workflow process mapping and redesign 6. Training and support of users 7. Communication 8. Woman centred approach 9. Outcome measures and evaluation
Editor's Notes
- #3: There are numerous questions to in relation to the above primary research question that were explored through the literature review. These include: What elements are critical to incorporate within an EHR, particularly the design and functionality that enables the IT system to be used in real time and in an acute setting? Internationally have there been any instances where a full EHR is used in a maternity environment? To what capacity are electronic records used in other health services, and what are the barriers to full implementation? Have end to end, fully integrative EHRs been implemented successfully in related acute health services? How do you build user confidence in IT? How does an organisation demonstrate readiness for change? What is the best approach to implementation i.e. staged, piloted, incremental or complete go live? How is the implementation process best managed, and what support is required to users, from the outset and on-going with the system? What would be the critical success factors with the implementation of this type of system into a maternity service? An attempt was made to answer these questions through the research proposed in order to inform the implementation project for the MICS system.
- #4: primary purpose behind the search was to elicit findings, opinions, or lessons learnt from recent experts on organisations that have recently implemented a complete, integrative electronic record within a substantive health service i.e. looking for large scale initiatives.