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A Critical Analysis on Evidence-Based Management of Ambulatory Electronic Health Record System Implementation: An Assessment of Conceptual Support and Qualitative Evidence

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A Critical Analysis on Evidence-Based Management of Ambulatory Electronic Health Record System Implementation: An Assessment of Conceptual Support and Qualitative Evidence

Ameshea Hines-Taylor

        Information systems in healthcare are growing rapidly each year, and electronic health record  (EHR) systems are one of the most evolved systems created. The purpose of EHRs is to decrease costs, increase efficiency, and minimize health errors. This study focuses on ambulatory health records, which are used to increase a physician’s productivity. Despite all the incentives to use EHRs, only 34% of office-based physicians used them in 2011. According to McAlearney et al., the lack of success is due to organizational issues versus technological issues. I agree that organizational issues are to be at fault; however, I believe this article also has its faults.

        The take home message from this study is that EHR can be successfully managed under the following criteria are met: (a) guided by the Plan-Do-Study-Act (PDSA) quality improvement model; (b) using evidence from evidence-based health systems management (EBHSM); (c) focusing on workflow; (d) incorporating critical management factors to facilitate management. Furthermore, critical management considerations to facilitate the EHR implementation include five critical factors: commitment, convincing/converting, communication, coordination, and change management.

The researchers comprised the sample from six U.S. healthcare organizations, three of which had formerly won health informatics rewards; key informatics interviews as well as focus groups were conducted. The same project investigator lead each interview and focus group along with three research assistants.  In total, 45 organizational and clinical personnel participated in the interviews, while 37 physicians participated in the focus groups.

The underlying assumption is that the PDSA QI model can improve the implementation of EHRs.  However, this study is flawed based on three reasons: small sample size, biased researchers/health sites, and no randomization. They looked at organizations that had been already recognized for its success using EHRs, but failed to explore organizations that had been unsuccessful. The researchers conducting the study were biased due their knowledge of health information systems. When speaking to one of the doctors in the focus group, it astonished me that he felt as though it was solely the nurses’ job to learn how the systems operate. I believe that the physician should not only be fluent in the use of the software, but also work collaboratively with other staff in the workplace.

        This article relays, in great detail, the concepts we have studied the past four weeks. It shows that EHRs can be effective if implemented correctly. The article also demonstrates the importance of training and the benefit of using evidenced in an effort to learn from past experiences.  However, due to the small sample size and biased group of interviewers as well as researchers, I cannot support the validity of this study. This article can be used as a stepping-stone for further research on how EHR can be effective, but its flaws interfere with the external validity. Additionally, I would love to see how the correct implementation of EHR affects clinical and financial aspects. Change is never easy, but health care is an ever-changing entity, and we have to be willing to adapt. Moreover, we should use other countries as resources, learning from the successes of their effective systems.

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