Implementation of a Hospital Electronic Surgical Registry in a Lower-Middle-Income Country
Implementation of a Hospital Electronic Surgical Registry in a Lower-Middle-Income Country
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DOI：
10.1007/s00268-016-3654-3
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发表时间：
2016-12-01
影响因子：
2.6
通讯作者：
Puyana, Juan Carlos
中科院分区：
文献类型：
--
作者：
Dasari, Mohini;Garbett, Marcelo;Puyana, Juan Carlos
虽然在发达国家和中低收入国家使用电子健康记录（EHR）的好处是众所周知的，但在中低收入国家实施EHR的障碍尚未得到充分描述。我们评估了实施移动的（基于平板电脑的）EHR的组织准备情况，以创建一个实时的电子手术注册表，在一个忙碌的中低收入国家hospital.Six半结构化的焦点小组进行了与医院管理人员，外科医生，外科住院医师，实习生，护士和医科学生在巴拉圭亚松森的一个大型城市医院。在执行前阶段，在三周的时间里，举行了重点小组会议，以查明执行工作的障碍。焦点组数据采用理论领域框架（Theoretical Domains Framework，TDF）进行编码，TDF包括12个与行为改变相关的领域，其中强化、环境背景/资源和角色/责任是最相关的TDF领域。居民和学生比教师和部门负责人更不确定谁将强制使用该工具来代替纸质图表。互联网质量是所有人都提出的一个关切。外科部门内部的地方性、规范性等级结构，包括部门负责人和住院医师之间关于角色和责任的零碎沟通，是实施的主要障碍。和技术基础设施是在将EHR引入中低收入国家的实施前阶段需要解决的潜在障碍，收入国家外科服务。在执行之前与所有利益攸关方一起消除这些潜在障碍将是这项工作的关键下一步。
While the benefits of using electronic health records (EHRs) in both developed and low- and middle-income countries are known, the barriers to implementing EHRs in lower-middle-income countries have not been fully characterized. We assessed organizational readiness for implementation of a mobile (tablet-based) EHR, to create a real-time electronic surgical registry, in a busy lower-middle-income country hospital.Six semi-structured focus groups were conducted with hospital administrators, faculty surgeons, surgical residents, interns, nurses and medical students in a large urban hospital in Asuncion, Paraguay. Focus groups were conducted over the course of three weeks during the pre-implementation phase to identify barriers to implementation. Focus group data were coded using the Theoretical Domains Framework (TDF), which are 12 validated domains related to behavior change.Reinforcement, environmental context/resources and roles/responsibilities were the most relevant TDF domains that emerged. Residents and students were more uncertain than faculty and department heads about who would enforce the use of the tool in place of paper charting. Internet quality was a concern raised by all. The local, normative hierarchical structure within the surgical department, including piecemeal communication between the department heads and the residents about roles and responsibilities, was a major perceived barrier to implementation.Uncertainties about reinforcement, roles and responsibilities for using a novel EHR tool, and technology infrastructure are potential barriers to address in the pre-implementation phase of introducing an EHR to a lower-middle-income country surgical service. Addressing these potential barriers with all stakeholders prior to implementation will be a critical next step in this effort.