BMC Med Inform Decis Mak - Users' perspectives of key factors to implementing electronic health records in Canada: a Delphi study.

Tópicos

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Resumo

CKGROUND: Interoperable electronic health record (EHR) solutions are currently being implemented in Canada, as in many other countries. Understanding EHR users' perspectives is key to the success of EHR implementation projects. This Delphi study aimed to assess in the Canadian context the applicability, the importance, and the priority of pre-identified factors from a previous mixed-methods systematic review of international literature.METHODS: A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (= 75%) or moderate (= 60-74%) according to user groups' level of agreement on applicability and importance, partial (= 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance.RESULTS: Three Delphi rounds were completed by 64 participants. Levels of consensus of 100%, 64%, 64%, and 44% were attained on factors submitted to non-physician healthcare professionals, health information professionals, managers, and physicians, respectively. While agreement between and within user groups varied, key factors were prioritized if they were classified as strong (= 75% from questionnaire answers of user groups), for decision-making concerning EHR implementation. The 10 factors that were prioritized are perceived usefulness, productivity, motivation, participation of end-users in the implementation strategy, patient and health professional interaction, lack of time and workload, resources availability, management, outcome expectancy, and interoperability.CONCLUSIONS: Amongst all factors influencing EHR implementation identified in a previous systematic review, ten were prioritized through this Delphi study. The varying levels of agreement between and within user groups could mean that users' perspectives of each factor are complex and that each user group has unique professional priorities and roles in the EHR implementation process. As more EHR implementations in Canada are completed it will be possible to corroborate this preliminary result with a larger population of EHR users.

Resumo Limpo

ckground interoper electron health record ehr solut current implement canada mani countri understand ehr user perspect key success ehr implement project delphi studi aim assess canadian context applic import prioriti preidentifi factor previous mixedmethod systemat review intern literaturemethod threeround delphi studi held repres canadian ehr user group defin partner implement process use expect use ehr everyday activ group nonphysician healthcar profession health inform profession manag physician four bilingu onlin questionnair version develop factor identifi systemat review particip ask rate applic import factor main outcom measur consensus prioriti consensus defin priori strong moder accord user group level agreement applic import partial particip agre applic import consensus prioriti decisionmak defin factor strong consensus score fivepoint likert scale applic importanceresult three delphi round complet particip level consensus attain factor submit nonphysician healthcar profession health inform profession manag physician respect agreement within user group vari key factor priorit classifi strong questionnair answer user group decisionmak concern ehr implement factor priorit perceiv use product motiv particip endus implement strategi patient health profession interact lack time workload resourc avail manag outcom expect interoperabilityconclus amongst factor influenc ehr implement identifi previous systemat review ten priorit delphi studi vari level agreement within user group mean user perspect factor complex user group uniqu profession prioriti role ehr implement process ehr implement canada complet will possibl corrobor preliminari result larger popul ehr user

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