Nurse KTech's: UPM.MSHI.MI227: Road Blocks

You have been selected to be the project manager for a DOH project with the task of implementing a national EHR that all government hospitals will implement. Select at least three barriers to EHR implementation from the article that you believe to be the most important ones that might adversely affect your implementation. Explain and provide supporting cases/articles/information.

Translation: You are to run am EHR system across the whole country. Explain why it will fail. Go.

The research article by Boonstra and Broekhuis, which discusses the barriers to acceptance of electronic medical record systems by physicians, proposed a search and organization of problems and obstacles perceived by most medical practitioners. Below is an outline of their resulting taxonomy of issues:

A. FINANCIAL

1. High startup costs

2. High ongoing costs

3. Uncertainty over ROI

4. Lack of financial resources

B. TECHNICAL

1. Physicians and/or staff lacking computer skills

2. Lack of technical training and support

3. Complexity of the system

4. Limitations of the system

5. Lack of customizability

6. Lack of reliability

7. Interconnectivity/Standardization

8. Lack of computers/hardware

C. TIME

1. Time required to select, purchase, and implement the system

2. Time to learn the system

3. Time required to enter data

4. More time per patient

5. Time to convert patient records

D. PSYCHOLOGICAL

1. Lack of belief in EMRs

2. Need for control

E. SOCIAL

1. Uncertainty about the vendor

2. Lack of support from external parties

3. Interference with doctor-patient relationship

4. Lack of support from other colleagues

5. Lack of support from the management level

F. LEGAL

1. Privacy or security concerns

G. ORGANIZATIONAL

1. Organizational size

2. Organizational type

H. CHANGE PROCESS

1. Lack of support from the organizational culture

2. Lack of incentives

3. Lack of participation

4. Lack of leadership

Given that the project would entail managing the implementation of an electronic health record system in public and government-affiliated health institutions throughout the country, I would perceive a series of major of barriers that could appear to hinder the operation.

TECHNICAL

A quick personal study of curriculums[1] designed by the Commission on Higher Education for allied health and medical professionals revealed that there is very little to no inclusion of basic concepts in information technology. Though there have been some efforts in recent years in terms of the BSN program’s Nursing Informatics subject, most of these subjects do not appear to be adequate to prepare healthcare professionals in handling complex information systems, including electronic health records.

Personal experience [2]has taught me that the provision of opportunities for users to fine-tune the system to better suit their individual needs is a significantly essential factor in the success of the implementation. In one of my internship programs, I have encountered an instance where the mere problem regarding user interface was enough for more than half of a department’s staff to lose faith in an information system.

What I would consider as a limitation of the system, power supply in the country is rather unstable, even in recent days[3]. Brownouts still occur, prompting extensive formulation of backup and failsafe systems built around the electronic health record systems to be implemented, including the option of resorting back to full manual and paper records with it.

CHANGE PROCESS

Partly due to the above technical barrier, especially with regard to computer skills, there would be a resulting degree of hesitation and resistance from the information system’s target users – the doctors and other healthcare professionals. Pre-implementation measures [4]have been suggested in order to avoid such issues from occurring among end users, regardless of age, gender, or any other demographic information.

Support from management also provides a good level of advantage in favor of the implementation. Personal experience again has taught me that it would take a great deal of convincing from higher-ups to have systems put into place. Such was the case with a certain hospital I visited as a prerequisite to MI207. It was revealed that most staff members of the emergency department already have a penchant for technology, especially mobile medical applications. All it needed was approval from top management to release policies regarding the use of such apps for it to potentially become a legitimate part of everyday practice in the institution.

Change management [5]issues in terms of a lack of leadership would also be very likely during implementation of the system as responsible parties for such a relatively uncommon project is still to be determined.

The lack of incentive programs [6]in the country, whether on an organizational or even national level, also attributes to the problem. Without any highly perceivable sense of benefit in sight, there is very little motivation for most healthcare institutions to actually adopt information technologies into their day-to-day practices in providing patient care.

ORGANIZATIONAL

With strong relation to the previous major barrier, taking into consideration the type organization running is crucial in the success of the electronic health record system to be implemented. Not only does its culture significant, but also the very structure of the organization itself is essential.

Size of the organization [7]tends to matter as well, especially in larger healthcare institutions, where it was observed that healthcare staff members employed tend to make use of available functions and features present in implemented EHR systems, not like those employed in smaller facilities. There is a considerable upper management influence involved.

It has also been noted that small health institutions situated in rural settings face a relatively different set of obstacles when implementing technology, emphasizing the need to consider details such as upfront buy-in, phased approach toward implementation, among others[8].

CONCLUSION

With so many other issues that could be brought on to the table with every project implementation, there will always be the tendency that the above three will be mainstays in discussions. Problems regarding resources such as time and money would have, at some point, been much more manageable if not outright solvable if issues such as mastery of the system, facilitating proper implementation, and taking note of the organization to be implemented on were addressed.