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Barriers to Electronic
Health Record Adoption
Coursework 3 - MI 227 Clinical Laboratory Information System
Villareal, Mary Grace A.
24 February 2016

UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
Coursework Scenario
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.
Governance - Law and Policies on EHR Implementation
The use of Electronic Health Records (EHR) in other countries was widely supported
because of clear governance provided by their National Health Sector as well as drafted
incentives for Health Workers. This is especially crucial because the use and limitations of
use of EHR in our country is not clearly defined yet. In addition, the country has not been
able to provide Medical Professionals, Hospital, Insurance companies policies that can
support it’s use.
Parallel to these private and some government institutions alike resort to hiring
consultants to aid with their needs. The scope of the implemented information then varies
with what the institution has bought or developed, leaving little to no room for
interoperability among other health care services. Issues aising from ownership of data
and extent to which it shall be used alongside with other providers are a threat to privacy
and security issues. Client’s billing/insurance information shoud commit that the
practice’s information is kept separately and not accesible to other practices/providers.
Not having proper governance stems many conflicts in EHR adoption, there may be
laws that support IT issues but doesn’t clearly address topics specifically medical in
nature.
UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
Change Process - Transition from Paper to Digital Records
Medical professionals has been praciticing ther work through theoretical studies and
training, not included in their training are adapting work styles to accomodate EHR use.
Their focus is with bedside care and patient encounter, only minimal time is alloted in
from of computer screens and work-stations. Switch and transition from paper to digital
data is not a priority in EHR training, causing slow adoption and resistance from some
users.
Administrators and department heads should clearly define the changes and
outcome of the system once operational. Studies of how their workflow should help in
integrating the system after training is done. Users report that they lack the time to learn
and would slow down their work and in the end increasing workload. Proper training
initiatives that can lead to users mastering the system that will yield beneficial results
according to some researchers.
Financial Cost
Since the laws drafted for budget allocation are not available yet, proper allocation
on the expenses for obtaining/developing new software, hardware and manpower to lead
the transition from paper-based records. As the secretary of our national health agency, I
would form a committee that shall study the best way to justify a budget allocation for the
development of a National Health Information system, and best practices that will bring
our system upto speed with ones utilized/standard abroad.
We understand early on that this field is complex, but little by little we are exposed
to the extent of that complexity. The government has now played an active role in
building a national health information system. By employing the help of Key Influencers,
a Technical Working Group and Steering Committee was created. Their knowledge and
expertise on the field gave our the country a framework it needs to move forward, but the
hard and taxing labour doesn't end there.
To engage stakeholders with this endeavor to advance eHealth in our country, we
must make it so that they know that they are not spending money but rather investing for
the future, to bring access, quality and empowerment to each citizen.
UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
References:
Anderson, J. G. “Social, Ethical and Legal Barriers to E-Health.” International Journal
of Medical Informatics 76 (2007). doi:10.1016/j.ijmedinf.2006.09.016.
Boonstra, Albert, and Manda Broekhuis. “Barriers to the Acceptance of Electronic
Medical Records by Physicians from Systematic Review to Taxonomy and
Interventions.” BMC Health Services Research 10, no. 1 (2010): 1–17. doi:
10.1186/1472-6963-10-231.
Burt, C. W., and J. E. Sisk. “Which Physicians and Practices Are Using Electronic
Medical Records?” Health Affairs 24 (2005). doi:10.1377/hlthaff.24.5.1334.
Da’ve, D. “Benefits and Barriers to EMR Implementation.” Caring 23 (2004).
Davidson, E., and D. Heslinga. “Bridging the IT Adoption Gap for Small Physician
Practices: An Action Research Study on Electronic Health Records.” Information
Systems Management 24 (2007). doi:10.1080/10580530601036786.
DesRoches, C. M., E. G. Campbell, S. R. Rao, K. Donelan, T. G. Ferris, A. Jha, R.
Kaushal, et al. “Electronic Health Records in Ambulatory Care - A National Survey of
Physicians.” New England Journal of Medicine 359 (2008). doi:10.1056/
NEJMsa0802005.
Earnest, M. A., S. E. Ross, L. Wittevrongel, L. A. Moore, and C. T. Lin. “Use of a
Patient-Accessible Electronic Medical Record in a Practice for Congestive Heart
Failure: Patient and Physician Experiences.” Journal of the American Medical
Informatics Association 11 (2004). doi:10.1197/jamia.M1479.
Häyrinen, K., K. Saranto, and P. Nykänen. “Definition, Structure, Content, Use and
Impacts of Electronic Health Records: A Review of the Research Literature.”
International Journal of Medical Informatics 77 (2008). doi:10.1016/j.ijmedinf.
2007.09.001.
Jha, A. K., D. W. Bates, C. Jenter, E. J. Orav, J. Zheng, P. Cleary, and R. Simon.
“Electronic Health Records: Use, Barriers and Satisfaction Among Physicians Who
Care For Black and Hispanic Patients.” Journal of Evaluation in Clinical Practice 15
(2009). doi:10.1111/j.1365-2753.2008.00975.x.
Kemper, A. R., R. L. Uren, and S. J. Clark. “Adoption of Electronic Health Records in
Primary Care Pediatric Practices.” Pediatrics 118 (2006). doi:10.1542/peds.
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Laerum, H., G. Ellingsen, and A. Faxvaag. “Doctors’ Use of Electronic Medical
Records Systems in Hospitals: Cross Sectional Survey.” British Medical Journal 323
(2001). doi:10.1136/bmj.323.7325.1344.
Loomis, G. A., S. Ries, R. M. Saywell, and N. R. Thakker. “If Electronic Medical
Records Are So Great, Why Aren’t Family Physicians Using Them?” Journal of Family
Practice 51 (2002).
Ludwick, D. A., and J. Doucette. “Primary Care Physicians’ Experience with
Electronic Medical Records: Barriers to Implementation in a Fee-for-Service
Environment.” In International Journal of Telemedicine and Applications, 2009.
McCarthy, C., and D. Eastman. “Change Management Strategies for an Effective
EMR Implementations.” In HIMSS Chicago, 2010.
McLane, S. “Designing an EMR Planning Process Based on Staff Attitudes Toward
and Opinions About Computers in Healthcare.” Computers Informatics Nursing 23
(2005). doi:10.1097/00024665-200503000-00008.
Meade, B., D. Buckley, and M. Boland. “What Factors Affect the Use of Electronic
Patient Records by Irish GPs?” International Journal of Medical Informatics 78
(2009). doi:10.1016/j.ijmedinf.2009.03.004.
Meinert, D. B. “Resistance to Electronic Medical Records (EMRs): A Barrier to
Improved Quality of Care.” Issues in Informing Science & Information Technology 2
(2005).
Menachemi, N., A. Langley, and R. G. Brooks. “The Use of Information Technologies
Among Rural and Urban Physicians in Florida.” Journal of Medical Systems 31
(2007). doi:10.1007/s10916-007-9088-6.
Miller, R. H., and I. Sim. “Physicians’ Use of Electronic Medical Records: Barriers and
Solutions.” Health Affairs 23 (2004). doi:10.1377/hlthaff.23.2.116.
Pizziferri, L., A. F. Kittler, L. A. Volk, M. M. Honour, S. Gupta, S. Wang, T. Wang, M.
Lippincott, Q. Li, and D. W. Bates. “Primary Care Physician Time Utilization Before
and After Implementation of an Electronic Health Record: A Time-Motion Study.”
Journal of Biomedical Informatics 38 (2005). doi:10.1016/j.jbi.2004.11.009.
Randeree, E. “Exploring Physician Adoption of EMRs: A Multi-Case Analysis.”
Journal of Medical System 31 (2007). doi:10.1007/s10916-007-9089-5.
Reardon, J. L., and E. Davidson. “An Organisational Learning Perspective on the
Assimilation of Electronic Medical Records among Small Physician Practices.”
European Journal of Information Systems 16 (2007). doi:10.1057/palgrave.ejis.
3000714.
Shachak, A., M. Hadas-Dayagi, A. Ziv, and S. Reis. “Primary Care Physicians’ Use of
an Electronic Medical Record System: A Cognitive Task Analysis.” Journal of General
Internal Medicine 24 (2009). doi:10.1007/s11606-008-0892-6.
Simon, S. R., R. Kalshal, P. D. Cleary, C. A. Jenter, L. A. Volk, E. J. Oray, E. Burdick,
E. G. Poon, and W. W. Batees. “Physicians and Electronic Health Records "A
Statewide Survey.” Archives of Internal Medicine 167 (2007). doi:10.1001/archinte.
167.5.507.
Simon, S. R., R. Kalshal, P. D. Cleary, C. A. Jenter, L. A. Volk, E. J. Oray, E. Burdick,
E. G. Poon, and D. W. Bates. “Physicians and Electronic Health Records: A
Statewide Survey.” Archives of Internal Medicine 167 (2007). doi:10.1001/archinte.
167.5.507.
Study on the Legal Framework for Interoperable eHealth in Europe. Brussels:
European Commission, Directorate General Information Society, 2009.
Terry, A. L., C. F. Thorpe, G. G. Giles, J. B. Brown, S. B. Harris, G. J. Reid, A. Thind,
and M. Stewart. “Implementing Electronic Health Records.” Canadian Family
Physician 54 (2008).
“The Pre-Publication History for This Paper Can Be Accessed here:http://
www.biomedcentral.com/1472-6963/10/231/prepub,” n.d. http://
www.biomedcentral.com/1472-6963/10/231/prepub.
Valdes, I., D. C. Kibbe, G. Tolleson, M. E. Kunik, and L. A. Petersen. “Barriers to
Proliferation of Electronic Medical Records.” Informatics in Primary Care 12 (2004).
Vishwanath, A., and S. D. Scamurra. “Barriers to the Adoption of Electronic Health
Records: Using Concept Mapping to Develop a Comprehensive Empirical Model.”
Health Informatics Journal 13 (2007). doi:10.1177/1460458207076468.
Walter, Z., and M. S. Lopez. “Physician Acceptance of Information Technologies:
Role of Perceived Threat to Professional Autonomy.” Decision Support Systems 46
(2008). doi:10.1016/j.dss.2008.06.004.
Yamamoto, L. G., and A. N. Khan. “Challenges of Electronic Medical Record
Implementation in the Emergency Department.” Pediatric Emergency Care 22
(2006).
Cherry, Barbara J., Eric W. Ford, and Lori T. Peterson. “Experiences with Electronic
Health Records: Early Adopters in Long-Term Care Facilities.” Health Care
Management Review 36, no. 3 (September 2011): 265–74. doi:10.1097/HMR.
0b013e31820e110f.
Hsiao, Ju-Ling, Hui-Chuan Chang, and Rai-Fu Chen. “A Study of Factors Affecting
Acceptance of Hospital Information Systems: A Nursing Perspective.” The Journal of
Nursing Research: JNR 19, no. 2 (June 2011): 150–60. doi:10.1097/JNR.
0b013e31821cbb25.
Pelland, Kimberly, Rosa Baier, Blake Morphis, Samara Viner-Brown, and Rebekah
Gardner. “Health Information Technology (HIT) Adoption and Use by Rhode Island
Advance Practice Registered Nurses and Physician Assistants, 2013.” Rhode Island
Medical Journal (2013) 96, no. 12 (December 2013): 48–49.
UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS

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Barriers to Electronic Health Record Adoption

  • 1. Barriers to Electronic Health Record Adoption Coursework 3 - MI 227 Clinical Laboratory Information System Villareal, Mary Grace A. 24 February 2016
 UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
  • 2. Coursework Scenario 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. Governance - Law and Policies on EHR Implementation The use of Electronic Health Records (EHR) in other countries was widely supported because of clear governance provided by their National Health Sector as well as drafted incentives for Health Workers. This is especially crucial because the use and limitations of use of EHR in our country is not clearly defined yet. In addition, the country has not been able to provide Medical Professionals, Hospital, Insurance companies policies that can support it’s use. Parallel to these private and some government institutions alike resort to hiring consultants to aid with their needs. The scope of the implemented information then varies with what the institution has bought or developed, leaving little to no room for interoperability among other health care services. Issues aising from ownership of data and extent to which it shall be used alongside with other providers are a threat to privacy and security issues. Client’s billing/insurance information shoud commit that the practice’s information is kept separately and not accesible to other practices/providers. Not having proper governance stems many conflicts in EHR adoption, there may be laws that support IT issues but doesn’t clearly address topics specifically medical in nature. UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
  • 3. Change Process - Transition from Paper to Digital Records Medical professionals has been praciticing ther work through theoretical studies and training, not included in their training are adapting work styles to accomodate EHR use. Their focus is with bedside care and patient encounter, only minimal time is alloted in from of computer screens and work-stations. Switch and transition from paper to digital data is not a priority in EHR training, causing slow adoption and resistance from some users. Administrators and department heads should clearly define the changes and outcome of the system once operational. Studies of how their workflow should help in integrating the system after training is done. Users report that they lack the time to learn and would slow down their work and in the end increasing workload. Proper training initiatives that can lead to users mastering the system that will yield beneficial results according to some researchers. Financial Cost Since the laws drafted for budget allocation are not available yet, proper allocation on the expenses for obtaining/developing new software, hardware and manpower to lead the transition from paper-based records. As the secretary of our national health agency, I would form a committee that shall study the best way to justify a budget allocation for the development of a National Health Information system, and best practices that will bring our system upto speed with ones utilized/standard abroad. We understand early on that this field is complex, but little by little we are exposed to the extent of that complexity. The government has now played an active role in building a national health information system. By employing the help of Key Influencers, a Technical Working Group and Steering Committee was created. Their knowledge and expertise on the field gave our the country a framework it needs to move forward, but the hard and taxing labour doesn't end there. To engage stakeholders with this endeavor to advance eHealth in our country, we must make it so that they know that they are not spending money but rather investing for the future, to bring access, quality and empowerment to each citizen. UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS
  • 4. References: Anderson, J. G. “Social, Ethical and Legal Barriers to E-Health.” International Journal of Medical Informatics 76 (2007). doi:10.1016/j.ijmedinf.2006.09.016. Boonstra, Albert, and Manda Broekhuis. “Barriers to the Acceptance of Electronic Medical Records by Physicians from Systematic Review to Taxonomy and Interventions.” BMC Health Services Research 10, no. 1 (2010): 1–17. doi: 10.1186/1472-6963-10-231. Burt, C. W., and J. E. Sisk. “Which Physicians and Practices Are Using Electronic Medical Records?” Health Affairs 24 (2005). doi:10.1377/hlthaff.24.5.1334. Da’ve, D. “Benefits and Barriers to EMR Implementation.” Caring 23 (2004). Davidson, E., and D. Heslinga. “Bridging the IT Adoption Gap for Small Physician Practices: An Action Research Study on Electronic Health Records.” Information Systems Management 24 (2007). doi:10.1080/10580530601036786. DesRoches, C. M., E. G. Campbell, S. R. Rao, K. Donelan, T. G. Ferris, A. Jha, R. Kaushal, et al. “Electronic Health Records in Ambulatory Care - A National Survey of Physicians.” New England Journal of Medicine 359 (2008). doi:10.1056/ NEJMsa0802005. Earnest, M. A., S. E. Ross, L. Wittevrongel, L. A. Moore, and C. T. Lin. “Use of a Patient-Accessible Electronic Medical Record in a Practice for Congestive Heart Failure: Patient and Physician Experiences.” Journal of the American Medical Informatics Association 11 (2004). doi:10.1197/jamia.M1479. Häyrinen, K., K. Saranto, and P. Nykänen. “Definition, Structure, Content, Use and Impacts of Electronic Health Records: A Review of the Research Literature.” International Journal of Medical Informatics 77 (2008). doi:10.1016/j.ijmedinf. 2007.09.001. Jha, A. K., D. W. Bates, C. Jenter, E. J. Orav, J. Zheng, P. Cleary, and R. Simon. “Electronic Health Records: Use, Barriers and Satisfaction Among Physicians Who Care For Black and Hispanic Patients.” Journal of Evaluation in Clinical Practice 15 (2009). doi:10.1111/j.1365-2753.2008.00975.x. Kemper, A. R., R. L. Uren, and S. J. Clark. “Adoption of Electronic Health Records in Primary Care Pediatric Practices.” Pediatrics 118 (2006). doi:10.1542/peds. 2005-3000. Laerum, H., G. Ellingsen, and A. Faxvaag. “Doctors’ Use of Electronic Medical Records Systems in Hospitals: Cross Sectional Survey.” British Medical Journal 323 (2001). doi:10.1136/bmj.323.7325.1344. Loomis, G. A., S. Ries, R. M. Saywell, and N. R. Thakker. “If Electronic Medical Records Are So Great, Why Aren’t Family Physicians Using Them?” Journal of Family Practice 51 (2002). Ludwick, D. A., and J. Doucette. “Primary Care Physicians’ Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment.” In International Journal of Telemedicine and Applications, 2009. McCarthy, C., and D. Eastman. “Change Management Strategies for an Effective EMR Implementations.” In HIMSS Chicago, 2010. McLane, S. “Designing an EMR Planning Process Based on Staff Attitudes Toward and Opinions About Computers in Healthcare.” Computers Informatics Nursing 23 (2005). doi:10.1097/00024665-200503000-00008. Meade, B., D. Buckley, and M. Boland. “What Factors Affect the Use of Electronic Patient Records by Irish GPs?” International Journal of Medical Informatics 78 (2009). doi:10.1016/j.ijmedinf.2009.03.004. Meinert, D. B. “Resistance to Electronic Medical Records (EMRs): A Barrier to Improved Quality of Care.” Issues in Informing Science & Information Technology 2 (2005). Menachemi, N., A. Langley, and R. G. Brooks. “The Use of Information Technologies Among Rural and Urban Physicians in Florida.” Journal of Medical Systems 31 (2007). doi:10.1007/s10916-007-9088-6. Miller, R. H., and I. Sim. “Physicians’ Use of Electronic Medical Records: Barriers and Solutions.” Health Affairs 23 (2004). doi:10.1377/hlthaff.23.2.116. Pizziferri, L., A. F. Kittler, L. A. Volk, M. M. Honour, S. Gupta, S. Wang, T. Wang, M. Lippincott, Q. Li, and D. W. Bates. “Primary Care Physician Time Utilization Before and After Implementation of an Electronic Health Record: A Time-Motion Study.” Journal of Biomedical Informatics 38 (2005). doi:10.1016/j.jbi.2004.11.009. Randeree, E. “Exploring Physician Adoption of EMRs: A Multi-Case Analysis.” Journal of Medical System 31 (2007). doi:10.1007/s10916-007-9089-5. Reardon, J. L., and E. Davidson. “An Organisational Learning Perspective on the Assimilation of Electronic Medical Records among Small Physician Practices.” European Journal of Information Systems 16 (2007). doi:10.1057/palgrave.ejis. 3000714. Shachak, A., M. Hadas-Dayagi, A. Ziv, and S. Reis. “Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis.” Journal of General Internal Medicine 24 (2009). doi:10.1007/s11606-008-0892-6. Simon, S. R., R. Kalshal, P. D. Cleary, C. A. Jenter, L. A. Volk, E. J. Oray, E. Burdick, E. G. Poon, and W. W. Batees. “Physicians and Electronic Health Records "A Statewide Survey.” Archives of Internal Medicine 167 (2007). doi:10.1001/archinte. 167.5.507. Simon, S. R., R. Kalshal, P. D. Cleary, C. A. Jenter, L. A. Volk, E. J. Oray, E. Burdick, E. G. Poon, and D. W. Bates. “Physicians and Electronic Health Records: A Statewide Survey.” Archives of Internal Medicine 167 (2007). doi:10.1001/archinte. 167.5.507. Study on the Legal Framework for Interoperable eHealth in Europe. Brussels: European Commission, Directorate General Information Society, 2009. Terry, A. L., C. F. Thorpe, G. G. Giles, J. B. Brown, S. B. Harris, G. J. Reid, A. Thind, and M. Stewart. “Implementing Electronic Health Records.” Canadian Family Physician 54 (2008). “The Pre-Publication History for This Paper Can Be Accessed here:http:// www.biomedcentral.com/1472-6963/10/231/prepub,” n.d. http:// www.biomedcentral.com/1472-6963/10/231/prepub. Valdes, I., D. C. Kibbe, G. Tolleson, M. E. Kunik, and L. A. Petersen. “Barriers to Proliferation of Electronic Medical Records.” Informatics in Primary Care 12 (2004). Vishwanath, A., and S. D. Scamurra. “Barriers to the Adoption of Electronic Health Records: Using Concept Mapping to Develop a Comprehensive Empirical Model.” Health Informatics Journal 13 (2007). doi:10.1177/1460458207076468. Walter, Z., and M. S. Lopez. “Physician Acceptance of Information Technologies: Role of Perceived Threat to Professional Autonomy.” Decision Support Systems 46 (2008). doi:10.1016/j.dss.2008.06.004. Yamamoto, L. G., and A. N. Khan. “Challenges of Electronic Medical Record Implementation in the Emergency Department.” Pediatric Emergency Care 22 (2006). Cherry, Barbara J., Eric W. Ford, and Lori T. Peterson. “Experiences with Electronic Health Records: Early Adopters in Long-Term Care Facilities.” Health Care Management Review 36, no. 3 (September 2011): 265–74. doi:10.1097/HMR. 0b013e31820e110f. Hsiao, Ju-Ling, Hui-Chuan Chang, and Rai-Fu Chen. “A Study of Factors Affecting Acceptance of Hospital Information Systems: A Nursing Perspective.” The Journal of Nursing Research: JNR 19, no. 2 (June 2011): 150–60. doi:10.1097/JNR. 0b013e31821cbb25. Pelland, Kimberly, Rosa Baier, Blake Morphis, Samara Viner-Brown, and Rebekah Gardner. “Health Information Technology (HIT) Adoption and Use by Rhode Island Advance Practice Registered Nurses and Physician Assistants, 2013.” Rhode Island Medical Journal (2013) 96, no. 12 (December 2013): 48–49. UNIVERSITY OF THE PHILIPPINES- MANILA MS HEALTH INFORMATICS