1.  Medical Groups' Adoption of Electronic Health Records and Information Systems

Author(s): Gans D, Kralewski J, Hammons T, Dowd B

Source: Health Affairs (Millwood--Spring Hope). 2005 Sep-Oct;24(5):1323-1333.

Summary: We surveyed a nationally representative sample of medical group practices to assess their current use of information technology (IT). Our results suggest that adoption of electronic health records (EHRs) is progressing slowly, at least in smaller practices, although a number of group practices plan to implement an EHR within the next two years.  Benefits of implementing an EHR include improved access to medical record information, workflow, patient communications, and accuracy for coding evaluation and management procedures.  For those both with and without EHRs, the top five barriers were related to aspects of costs and to concern about physicians' support and ability to use the new system.  Overall, the process of choosing and implementing an EHR appears to be more complex and varied than we expected. This suggests a need for greater support for practices, particularly smaller ones, in this quest if the benefits expected from EHRs are to be realized.

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2.  Physicians' Use of Electronic Medical Records: Barriers and Solutions

Author(s): Miller RH, Sim I

Source: Health Affairs (Millwood--Spring Hope). 2004 Mar-Apr;23(2):116-126.

Summary: The electronic medical record (EMR) is an enabling technology that allows physician practices to pursue more powerful quality improvement programs than is possible with paper-based records. However, achieving quality improvement through EMR use is neither low-cost nor easy. Based on a qualitative study of physician practices that had implemented an EMR, we found that quality improvement depends heavily on physicians' use of the EMR-and not paper-for most of their daily tasks. The key barriers to physicians' use of EMRs include high initial costs and uncertain financial benefits; high initial physician time costs to learn the system; difficulties with technology, including EMR usability; and difficult complementary changes and inadequate support from both IT support and EMR vendors. We then suggest policy interventions to overcome these barriers, including providing work/practice support systems, improving electronic clinical data exchange, and providing financial rewards for quality improvement.

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3.  Implementing Information Systems in Health Care Organizations: Myths and Challenges

Author(s): Berg M

Source: International Journal of Medical Informatics. 2001 Dec;64(2):143-156.

Summary: Successfully implementing patient care information systems (PCISs) in health care organizations appears to be a difficult task. After critically examining the very notions of 'success' and 'failure', and discussing the problematic nature of lists of 'critical success- or failure factors', this paper discusses three myths that often hamper implementation processes. First of all, PCIS implementation is a process of mutual transformation; the organization and the technology transform each other during the implementation process, which in turn can transform the organization. Secondly, successful PCIS implementation occurs when properly supported by both central management and future users; a top down framework for the implementation is crucial to turn user-input into a coherent steering force. Finally, the management of IS implementation processes is a balancing act between initiating organizational change, and drawing upon IS as a change agent, without attempting to pre-specify and control this process. Accepting, and even drawing upon, this inevitable uncertainty might be the hardest lesson to learn.

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4.  Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals

Author(s): Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R

Source: Health Affairs (Project Hope). 2004 Jul-Aug;23(4):184-190.

Summary: Few U.S. hospitals have implemented computerized physician order entry (CPOE) in spite of its effectiveness at preventing serious medication errors. We conducted in-depth interviews with senior management at 26 hospitals to identify ways to overcome barriers to adopting and implementing CPOE. Within the hospital, strong leadership, identifying physician champions of CPOE, leveraging the knowledge of younger physicians exposed to CPOE in medical school, and addressing workflow concerns were critical for successful implementation.  Additionally, hospitals that placed a high priority on patient safety and showed CPOE's impact on hospital efficiency could more easily justify the cost of CPOE. Outside the hospital, financial incentives and public pressures encouraged CPOE adoption. Disseminating data standards and providing third-party payer incentives would accelerate the maturation of vendors and lower CPOE costs. These findings highlight several policy levers to speed the adoption of this important patient safety technology.

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5.  Disseminating Innovations in Healthcare

Author(s): Berwick, DM

Source: JAMA: The Journal of the American Medical Association. 2003 Apr 16;289(15):1969-1975.

Summary: Health care is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly-if at all. Diffusion of innovations is a major challenge in all industries, including health care. This article examines the theory and research on the dissemination of innovations and suggests applications of that theory to health care. It explores in detail three clusters of influence on the rate of diffusion of innovations within an organization: the perceptions of the innovation, the characteristics of the individuals who may adopt the change, and contextual and managerial factors within the organization. This theory makes plausible at least seven recommendations for health care executives who want to accelerate the rate of diffusion of innovations within their organizations: find sound innovations, find and support "innovators", invest in "early adopters", make early adopter activity observable, trust and enable reinvention, create slack for change, and lead by example.

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6.  Managing Change: An Overview

Author(s): Lorenzi NM, Riley RT

Source: Journal of the American Medical Informatics Assocation (JAMIA). 2000 Mar-Apr;7(2):116-124.

Summary: As increasingly powerful informatics systems are designed, developed, and implemented, they inevitably affect larger, more heterogeneous groups of people and more organizational areas. In turn, the major challenges to system success are often more behavioral than technical. Successfully introducing such systems into complex health care organizations requires an effective blend of good technical and good organizational skills. People who have low psychological ownership in a system and who vigorously resist its implementation can bring a "technically best" system to its knees. However, effective leadership can sharply reduce the behavioral resistance to change-including to new technologies-to achieve a more rapid and productive introduction of informatics technology. This paper looks at four major areas: why information system failures occur, the core theories supporting change management, the practical applications of change management, and the change management efforts in informatics.