Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System This material (Comp7_Unit9) was developed by Johns Hopkins.

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Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System This material (Comp7_Unit9) was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC00013.

Potential Issues with Adoption and Installation of an HIT System Learning Objectives Identify frequently encountered challenges to adoption and implementation of HIT systems. Propose solutions to common problems in the implementation of HIT systems. Design a plan to address barriers to implementation of an HIT system. 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Why Do Systems Fail? Systems can “get in the way”. Is it useable? Lack of the story metaphor –“Narratives are essential to a patient's episode of illness.” –“Poor communication is more often detrimental to patients than lack of knowledge.” –“Computers should enable clinicians to capture narratives easily.” –“The structure of the patient's record strongly influences the ease of information retrieval.” (Walsh, 2004) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Understanding Critical Success Factors User Characteristics –Cognitive style, personality, demographics, situational variables, attitudes, expectations System Design Characteristics –Hard/software performance, learning, decision-support, usability, GUI Organizational Characteristics –organization culture, top level support, commitment 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Common Challenges to Adoption & Integration of HIT Hard to enter data –Free text – isn’t –Structured text Tough on the front end Easier on the back end Reading –40% slower online “If the computer is used to generate output, the layout structure of the reports are important as this can influence clinical decisions in sometimes fundamental ways.” (Walsh, 2004) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Effect of Presentation Order – “Primacy Effect” A: Diabetic Medication X This medication is effective; it lowers sugar levels. It makes one feel better and boosts energy. It may cause nausea and headache. B: Diabetic Medication Y This medication may cause headache and nausea. It boosts energy and makes one feel better. It is effective; it lowers sugar levels. (Neto, Chen and Chan, 2002) 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Common Challenges to Adoption & Integration of HIT 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

The Three T’s 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Intervention Strategies 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

ToolKits AHRQ Emerging Lessons Toolkit: – funded_projects/654/emerging_lessons/11227http://healthit.ahrq.gov/portal/server.pt/community/ahrq- funded_projects/654/emerging_lessons/11227 AAFP: HIT in the Small Office Online Tutorials – Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res. 2010; 10: 231. Available from: – HIMSS Flyer – Getting Started With An EHR – ACP: EHR Adoption Road Map and Tools – HRSA Implementation Tool Kit – tiontoolbox/ tiontoolbox/ 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Potential Issues with Adoption and Installation of an HIT System Summary Why do systems fail? Critical success factors Challenges to adoption and integration The three T’s Toolkits for your use 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Potential Issues with Adoption and Installation of an HIT System References References Adler, K. How to Successfully Navigate Your EHR Implementation; Family Practice Management February. Available from: Bartos, C., Bulter, B., Penrod, L., Fridsma, D., Crowley, R. Negative CPOE Attitudes Correlate with Diminished Power in the Workplace. AMIA Annu Symp Proc 2008; 2008: Available from: Neto, A., Chen, T. & Chan J. “Order effect" in the provision of medication information. MJA 2002; 176 (8): Psychiatric News; May 7, 2010 ; Volume 45 Number 9 Page 6; from the American Psychiatric Association. Available from: Trivedi, M., Daly, E., Kern. J., et al. Barriers to implementation of a computerized decision support system for depression: an observational report on lessons learned in "real world" clinical settings.” BMC Medial Informatics and Decision Making Available from: Walsh, S. The clinician's perspective on electronic health records and how they can affect patient care. BMJ 2004 May 15: 328(7449): Available from: Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System

Potential Issues with Adoption and Installation of an HIT System References Charts, Tables, Figures 9.1 Adler, K. How to Successfully Navigate Your EHR Implementation; Family Practice Management February. Available from: Boonstra, A., Broekhusis, M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research 2010, 10:231.Available from: Images Slide 2: Girl Flexing Muscles. Courtesy Dr. Patricia Abbott Slide 4: Beauty and the Beast. Available from: Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0) Slide 5: Shop Sign. Courtesy Dr. Patricia Abbott. Slide 6: Pills. Available from: Attribution-NonCommercial-NoDerivs 2.0 Generic (CC BY-NC-ND 2.0) SilverlinedWinnebago. Slide 7: Lion. Available from: GNU Free Documentation License 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Working with Health IT Systems Potential Issues with Adoption and Installation of an HIT System