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Book part
Publication date: 26 August 2010

Pavani Rangachari

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of…

Abstract

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of Computerized Physician Order Entry (CPOE) implementation include unfavorable workflow issues, generation of new types of errors, untoward changes in communication patterns, and problems of paper persistence.

However, gaps remain in understanding why UACs from HIT implementation occur, and how they may be overcome. The technology-in-practice (TIP) framework emphasizes the role of human agency (or individual action) in enacting structures of technology use (or technologies-in-practice) and other social structures within the organization. As such, given a set of UACs from HIT implementation, the TIP framework can help trace them back to specific actions (types of HIT-in-practice) and institutional conditions (social structures).

However, insofar as the TIP framework can help understand causes of UACs, it does not shed light on how they may be overcome through strategic action. By contrast, the knowledge-in-practice (KIP) framework, which emanates from both human resource and knowledge management literatures, helps understand how information and communication technologies (ICTs) such as “Intranets” and the “Virtual Office” can be used alongside existing HIT systems (e.g., CPOE) to create new social structures, generate new KIP, and transform HIT-in-practice.

This chapter integrates the TIP and KIP literatures to develop an integrated framework for understanding and overcoming the UACs from HIT implementation. The framework is applied to existing evidence on UACs from CPOE implementation, to explain why they occur, and how they may be overcome. The application and ensuing discussion provide insight into strategies for successful HIT implementation in healthcare organizations, as well as recommendations for future research.

Details

Strategic Human Resource Management in Health Care
Type: Book
ISBN: 978-1-84950-948-0

Article
Publication date: 1 July 2014

Nikunj Agarwal and M.P. Sebastian

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized…

Abstract

Purpose

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

Design/methodology/approach

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

Findings

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

Practical implications

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Originality/value

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

Details

Clinical Governance: An International Journal, vol. 19 no. 3
Type: Research Article
ISSN: 1477-7274

Keywords

Article
Publication date: 6 July 2010

Joel French and Robert Weathersby

Only 55% of patients receive recommended care, with little difference found between care recommended for prevention, to address acute episodes, or to treat chronic conditions …

Abstract

Only 55% of patients receive recommended care, with little difference found between care recommended for prevention, to address acute episodes, or to treat chronic conditions (McGlynn et al, 2003). The lag time between the discovery of more effective forms of medical treatment and their incorporation into routine patient care averages seventeen (17) years (IOM). Computerized provider order entry (CPOE) has been widely documented as a necessary tool to reduce preventable medication and other related errors but only 7.4% of acute care hospitals in the United States utilize CPOE with appropriate rules and evidence (HIMSS Analytics). The most fundamental building block for CPOE is the evidence based order set, but complexities associated with creating, managing and updating order sets have introduced major obstacles to CPOE implementation efforts. Chronic conditions such as heart disease, diabetes or arthritis affect more than 130 million Americans directly, and account for 7 in 10 deaths. Further, these chronic conditions consume 75% of all healthcare spending, and account for nearly two-thirds of the growth in health spending over the past 20 years -costing the U. S. economy $1 trillion annually (Almanac of Chronic Conditions, 2008 Edition). Estimates suggest the average patient upon hospitalization has 2.75 diagnoses - meaning "appropriate care" must span and synthesize multiple morbidity-specific best practices to effectively administer care to that "average" patient. The traditional approach to treating patients with evidence based protocols requires a physician to perform an ad hoc exercise of "mental merging" - reconciling duplicate candidate orders across multiple order sets to treat a patient with co-morbidities (today's norm). A more clinically effective, productive, and patient safety-centric alternative is to employ a proprietary software merging algorithm. These advanced algorithms remove duplicate orders, resolve conflicts, completes validation of the appropriate medical evidence and organizes the resulting merged order set so the physician can succinctly address the patients' often complicated treatment by focusing on the unique combination of labs, medications, etc. appropriate for the specific presenting conditions. This article describes a patent-pending propriety method of algorithmically merging multiple independent order sets for patients with co-morbid and chronic conditions into a single, maintenance free and evidence-based order set that can be immediately implemented into physician workflow to satisfy "Meaningful Use" guidelines for incremental provider reimbursement based on the American Recovery and Reinvestment Act (ARRA) legislation.

Details

International Journal of Innovation Science, vol. 2 no. 1
Type: Research Article
ISSN: 1757-2223

Open Access
Article
Publication date: 16 November 2015

Steven Cranfield, Jane Hendy, Barnaby Reeves, Andrew Hutchings, Simon Collin and Naomi Fulop

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised…

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Abstract

Purpose

The purpose of this paper is to better understand how and why adoption and implementation of healthcare IT innovations occur. The authors examine two IT applications, computerised physician order entry (CPOE) and picture archiving and communication systems (PACS) at the meso and micro levels, within the context of the National Programme for IT in the English National Health Service (NHS).

Design/methodology/approach

To analyse these multi-level dynamics, the authors blend Rogers’ diffusion of innovations theory (DoIT) with Webster’s sociological critique of technological innovation in medicine and healthcare systems to illuminate a wider range of interacting factors. Qualitative data collected between 2004 and 2006 uses semi-structured, in-depth interviews with 72 stakeholders across four English NHS hospital trusts.

Findings

Overall, PACS was more successfully implemented (fully or partially in three out of four trusts) than CPOE (implemented in one trust only). Factors such as perceived benefit to users and attributes of the application – in particular speed, ease of use, reliability and flexibility and levels of readiness – were highly relevant but their influence was modulated through interaction with complex structural and relational issues.

Practical implications

Results reveal that combining contextual system level theories with DoIT increases understanding of real-life processes underpinning implementation of IT innovations within healthcare. They also highlight important drivers affecting success of implementation, including socio-political factors, the social body of practice and degree of “co-construction” between designers and end-users.

Originality/value

The originality of the study partly rests on its methodological innovativeness and its value on critical insights afforded into understanding complex IT implementation programmes.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

Book part
Publication date: 6 July 2011

Patrick Albert Palmieri, Lori T. Peterson and Luciano Bedoya Corazzo

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health…

Abstract

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

Article
Publication date: 3 October 2008

Jeffrey P. Harrison and Geoffrey M. McDowell

The purpose of this study was to evaluate the status of US hospital Laboratory Information Systems. Laboratory Information Systems are critical to high quality healthcare service…

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Abstract

Purpose

The purpose of this study was to evaluate the status of US hospital Laboratory Information Systems. Laboratory Information Systems are critical to high quality healthcare service provision. Data show that the need for these systems is growing to meet accompanying technological and workload demands. Additionally, laboratory tests provide the majority of information for clinical decision‐making. Laboratory processes automation, including patient result verification, has greatly improved laboratory test throughput while decreasing turn‐around‐times, enabling critical results to reach physicians rapidly for improved clinical outcomes.

Design/methodology/approach

Data were drawn from the 2007 Healthcare Information and Management Systems Society (HIMSS) Analytics Database, which includes over 5,000 US healthcare organizations and provides extensive data on the hardware, software, and information technology infrastructure within healthcare organizations.

Findings

US hospitals are actively involved in laboratory systems planning to improve health service quality. Specifically, data show 76 new laboratory information systems are currently being installed in 2007 with another 399 under contract for future installation. As a result, increasing investment in laboratory information systems is providing state‐of‐the‐art clinical laboratory support, which enhances clinical care processes and improves quality. These state‐of‐the‐art Laboratory Information Systems, when linked with other clinical information systems such as Computerized Physician Order Entry and Electronic Medical Record, will support further healthcare quality improvement.

Originality/value

This article includes the most current information available on the US hospital laboratory information system applications.

Details

International Journal of Health Care Quality Assurance, vol. 21 no. 7
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 12 July 2013

Godfrey Isouard

The purpose of this paper is to discuss the challenges faced in Australia to maintain and sustain quality in pathology services, and present new strategic directions to address…

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Abstract

Purpose

The purpose of this paper is to discuss the challenges faced in Australia to maintain and sustain quality in pathology services, and present new strategic directions to address such challenges.

Design/methodology/approach

The paper is a review of the literature on pathology services and its quality of delivery and emerging issues.

Findings

Major issues are emerging in pathology services which threaten to impact on the quality of future service delivery. These issues include workforce shortages, growth in inappropriate testing, advancing technology, rural and remote region servicing, and a negative image of the sector. New strategic directions are shown to be necessary in terms of workforce planning and addressing the escalation of new technology and innovation. In order to sustain quality of services, a significant change from current practice is recommended, with strong leadership as the change driver.

Practical implications

This paper highlights the potential impact of emerging issues on future pathology‐service quality. Significant implications for service delivery and patient care quality are reviewed.

Originality/value

This paper provides valuable information on current strategic and planning issues impacting on pathology services. It provides new solutions from the perspective of leadership of health and health services.

Details

International Journal of Health Care Quality Assurance, vol. 26 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 12 April 2013

Alina M. Chircu, Janis L. Gogan, Scott R. Boss and Ryan Baxter

The purpose of this paper is to examine how clinical handoffs affect clinical information quality (IQ) and medication administration quality.

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Abstract

Purpose

The purpose of this paper is to examine how clinical handoffs affect clinical information quality (IQ) and medication administration quality.

Design/methodology/approach

A case study was conducted in a US hospital. The authors applied a business process management (BPM) perspective to analyze an end‐to‐end medication administration process and related handoffs, and accounting control theory (ACT) to examine the impact of handoffs on IQ and medication errors.

Findings

The study reveals how handoffs can lead to medication errors (by passing information that is not complete, accurate, timely or valid) and can help reduce errors (by preventing, detecting and correcting information quality flaws or prior clinical mistakes).

Research limitations/implications

The paper reports on one case study on one hospital unit. Future studies can investigate the impact of clinical IQ on patient safety across the multitude of health information technologies (e.g. computerized provider order entry (CPOE), electronic medication administration records (EMAR), and barcode medication administration systems (BCMA)) and approaches to process design and support (e.g. use of clinical pathways and checklists).

Practical implications

The findings can contribute to more successful design, implementation and evaluation of medication administration and other clinical processes, ultimately improving patient safety.

Originality/value

The paper's main contribution is the use of accounting control theory to systematically focus on IQ to evaluate and improve end‐to‐end medical administration processes.

Article
Publication date: 7 January 2020

Zhiqiang Huang, Lei He, ZhaoXin Gao, Yingqi Jia, Yewei Kang, Dou Xie and Chunli Fu

This paper aims to introduce a new acoustic positioning method to solve the problem of space positioning for online inspection robots within the storage tank.

Abstract

Purpose

This paper aims to introduce a new acoustic positioning method to solve the problem of space positioning for online inspection robots within the storage tank.

Design/methodology/approach

The proposed positioning system comprises two acoustic signal emitters and two receivers. Emitters are brought by the robot into the storage tank. Receivers are mounted on the external edge of the storage tank floor. The spatial coordinate values and motion directions of the robot in the storage tank are calculated by using the proposed acoustic positioning algorithm.

Findings

The experiment results and positioning error analysis indicate that the method can obtain the data of robotic space coordinates and motion orientation, while the positioning error of the method can be less than 20 cm. The accuracy reaches the positioning technology level of other tank online inspection robots.

Originality/value

This method not only expands the positioning of the inspection robots from 2D plane to 3D space but also significantly reduces the number of positioning sensors carried by a robot and improves the safety of a robot in the tank.

Details

Industrial Robot: the international journal of robotics research and application, vol. 47 no. 2
Type: Research Article
ISSN: 0143-991X

Keywords

Book part
Publication date: 31 July 2013

Rebecca R. Kitzmiller, Reuben R. McDaniel, Constance M. Johnson, E. Allan Lind and Ruth A. Anderson

We examine how interpersonal behavior and social interaction influence team sensemaking and subsequent team actions during a hospital-based health information technology (HIT…

Abstract

Purpose

We examine how interpersonal behavior and social interaction influence team sensemaking and subsequent team actions during a hospital-based health information technology (HIT) implementation project.

Design/methodology/approach

Over the course of 18 months, we directly observed the interpersonal interactions of HIT implementation teams using a sensemaking lens.

Findings

We identified three voice-promoting strategies enacted by team leaders that fostered team member voice and sensemaking; communicating a vision; connecting goals to team member values; and seeking team member input. However, infrequent leader expressions of anger quickly undermined team sensemaking, halting dialog essential to problem solving. By seeking team member opinions, team leaders overcame the negative effects of anger.

Practical implications

Leaders must enact voice-promoting behaviors and use them throughout a team’s engagement. Further, training teams in how to use conflict to achieve greater innovation may improve sensemaking essential to project risk mitigation.

Social implications

Health care work processes are complex; teams involved in implementing improvements must be prepared to deal with conflicting, contentious issues, which will arise during change. Therefore, team conflict training may be essential to sustaining sensemaking.

Research implications

Future research should seek to identify team interactions that foster sensemaking, especially when topics are difficult or unwelcome, then determine the association between staff sensemaking and the impact on HIT implementation outcomes.

Value/originality

We are among the first to focus on project teams tasked with HIT implementation. This research extends our understanding of how leaders’ behaviors might facilitate or impeded speaking up among project teams in health care settings.

Details

Leading in Health Care Organizations: Improving Safety, Satisfaction and Financial Performance
Type: Book
ISBN: 978-1-78190-633-0

Keywords

1 – 10 of 49