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Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

BACKGROUND: Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation. METHODS: Semi-structured interviews were conducted in two con...

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Autores principales: Barnes, Geoffrey D., Sippola, Emily, Ranusch, Allison, Takamine, Linda, Lanham, Michael, Dorsch, Michael, Sales, Anne, Sussman, Jeremy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812192/
https://www.ncbi.nlm.nih.gov/pubmed/35109916
http://dx.doi.org/10.1186/s43058-022-00262-w
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author Barnes, Geoffrey D.
Sippola, Emily
Ranusch, Allison
Takamine, Linda
Lanham, Michael
Dorsch, Michael
Sales, Anne
Sussman, Jeremy
author_facet Barnes, Geoffrey D.
Sippola, Emily
Ranusch, Allison
Takamine, Linda
Lanham, Michael
Dorsch, Michael
Sales, Anne
Sussman, Jeremy
author_sort Barnes, Geoffrey D.
collection PubMed
description BACKGROUND: Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation. METHODS: Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI(2) sites. RESULTS: Among 45 interviewees (32 in VA, 13 in MAQI(2)), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI(2) (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI(2) (lower baseline levels, less concern). CONCLUSIONS: The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-022-00262-w.
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spelling pubmed-88121922022-02-03 Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process Barnes, Geoffrey D. Sippola, Emily Ranusch, Allison Takamine, Linda Lanham, Michael Dorsch, Michael Sales, Anne Sussman, Jeremy Implement Sci Commun Research BACKGROUND: Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation. METHODS: Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI(2) sites. RESULTS: Among 45 interviewees (32 in VA, 13 in MAQI(2)), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI(2) (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI(2) (lower baseline levels, less concern). CONCLUSIONS: The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s43058-022-00262-w. BioMed Central 2022-02-02 /pmc/articles/PMC8812192/ /pubmed/35109916 http://dx.doi.org/10.1186/s43058-022-00262-w Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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
Barnes, Geoffrey D.
Sippola, Emily
Ranusch, Allison
Takamine, Linda
Lanham, Michael
Dorsch, Michael
Sales, Anne
Sussman, Jeremy
Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title_full Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title_fullStr Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title_full_unstemmed Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title_short Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
title_sort implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812192/
https://www.ncbi.nlm.nih.gov/pubmed/35109916
http://dx.doi.org/10.1186/s43058-022-00262-w
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