A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals.
A qualitative exploration of workarounds related to the implementation of national electronic health records in early adopter mental health hospitals.
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DOI：
10.1371/journal.pone.0077669
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Sheikh A
中科院分区：
文献类型：
--
作者：
Ser G;Robertson A;Sheikh A
调查精神卫生医院工作人员使用国家医院电子健康记录 (EHR) 的看法和报告的做法，以便为未来的实施提供信息，特别是在急性精神卫生环境中。对英国伦敦两家早期采用心理健康国家卫生服务 (NHS) 医院实施国家 EHR 的临床、信息技术 (IT)、管理和其他工作人员进行的访谈进行专题分析。我们分析了 33 份访谈。我们首先寻找解决方法的示例，例如延迟数据输入、在错误的位置输入数据以及以同事身份登录时使用 EHR 的个人，然后确定所报告的解决方法的可能原因。我们的分析确定了影响变通办法的四类主要因素（即运营、文化、组织和技术）。运营因素包括系统与现有工作流程的集成不佳以及系统无法满足用户的感知需求。文化因素涉及用户的 IT 能力和对变革的抵制。组织因素是指组织资源和培训不足，技术因素是当地技术基础设施不足。其中许多因素，例如将 EHR 系统与日常运营流程、员工培训和充足的当地 IT 基础设施相结合，可能适用于各种环境中的系统实施，但我们也确定了与在精神卫生医院实施 EHR 特别相关的因素，例如： EHR 系统与精神卫生相关部门（尤其是社会服务）使用的 IT 系统不兼容； EHR 系统缺乏具体的心理健康功能和选项；临床医生在照顾痛苦的精神病患者时感到无法使用计算机。更好的解决方法原因的概念模型应有助于设计、支持医院心理健康环境中使用的电子病历的实施和采用。
To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs) in order to inform future implementations, particularly in acute mental health settings. Thematic analysis of interviews with a wide range of clinical, information technology (IT), managerial and other staff at two early adopter mental health National Health Service (NHS) hospitals in London, UK, implementing national EHRs. We analysed 33 interviews. We first sought out examples of workarounds, such as delayed data entry, entering data in wrong places and individuals using the EHR while logged in as a colleague, then identified possible reasons for the reported workarounds. Our analysis identified four main categories of factors contributing to workarounds (i.e., operational, cultural, organisational and technical). Operational factors included poor system integration with existing workflows and the system not meeting users' perceived needs. Cultural factors involved users' competence with IT and resistance to change. Organisational factors referred to insufficient organisational resources and training, while technical factors included inadequate local technical infrastructure. Many of these factors, such as integrating the EHR system with day-to-day operational processes, staff training and adequate local IT infrastructure, were likely to apply to system implementations in various settings, but we also identified factors that related particularly to implementing EHRs in mental health hospitals, for example: EHR system incompatibility with IT systems used by mental health–related sectors, notably social services; the EHR system lacking specific, mental health functionalities and options; and clinicians feeling unable to use computers while attending to distressed psychiatric patients. A better conceptual model of reasons for workarounds should help with designing, and supporting the implementation and adoption of, EHRs for use in hospital mental health settings.
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DOI：
10.1197/jamia.m2616
发表时间：
2008-07-01
影响因子：
6.4
作者：
Koppel, Ross;Wetterneck, Tosha;Karsh, Ben-Tzion
通讯作者：
Karsh, Ben-Tzion
影响因子：
120.7
作者：
Bates, DW;Leape, LL;Seger, DL
通讯作者：
Seger, DL
DOI：
10.1136/bmj.c2581
发表时间：
2010-06-09
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Murray SA;Kendall M;Boyd K;Grant L;Highet G;Sheikh A
通讯作者：
Sheikh A
影响因子：
--
作者：
Huckvale, Christopher;Car, Josip;Majeed, Azeem
通讯作者：
Majeed, Azeem
案例研究方法。
影响因子：
4
作者：
Crowe S;Cresswell K;Robertson A;Huby G;Avery A;Sheikh A
通讯作者：
Sheikh A