Cargando…

Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands

BACKGROUND: Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless e...

Descripción completa

Detalles Bibliográficos
Autores principales: Heeney, Catherine, Bouamrane, Matt, Malden, Stephen, Cresswell, Kathrin, Williams, Robin, Sheikh, Aziz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568858/
https://www.ncbi.nlm.nih.gov/pubmed/37821881
http://dx.doi.org/10.1186/s12911-023-02316-y
_version_ 1785119441615323136
author Heeney, Catherine
Bouamrane, Matt
Malden, Stephen
Cresswell, Kathrin
Williams, Robin
Sheikh, Aziz
author_facet Heeney, Catherine
Bouamrane, Matt
Malden, Stephen
Cresswell, Kathrin
Williams, Robin
Sheikh, Aziz
author_sort Heeney, Catherine
collection PubMed
description BACKGROUND: Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems. METHODS: We undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems. RESULTS: Our thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture. CONCLUSIONS: Achieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12911-023-02316-y.
format Online
Article
Text
id pubmed-10568858
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-105688582023-10-13 Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands Heeney, Catherine Bouamrane, Matt Malden, Stephen Cresswell, Kathrin Williams, Robin Sheikh, Aziz BMC Med Inform Decis Mak Research BACKGROUND: Investment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems. METHODS: We undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems. RESULTS: Our thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture. CONCLUSIONS: Achieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12911-023-02316-y. BioMed Central 2023-10-11 /pmc/articles/PMC10568858/ /pubmed/37821881 http://dx.doi.org/10.1186/s12911-023-02316-y Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Heeney, Catherine
Bouamrane, Matt
Malden, Stephen
Cresswell, Kathrin
Williams, Robin
Sheikh, Aziz
Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title_full Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title_fullStr Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title_full_unstemmed Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title_short Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands
title_sort optimising eprescribing in hospitals through the interoperability of systems and processes: a qualitative study in the uk, us, norway and the netherlands
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568858/
https://www.ncbi.nlm.nih.gov/pubmed/37821881
http://dx.doi.org/10.1186/s12911-023-02316-y
work_keys_str_mv AT heeneycatherine optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands
AT bouamranematt optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands
AT maldenstephen optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands
AT cresswellkathrin optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands
AT williamsrobin optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands
AT sheikhaziz optimisingeprescribinginhospitalsthroughtheinteroperabilityofsystemsandprocessesaqualitativestudyintheukusnorwayandthenetherlands