Appl Clin Inform - CAH to CAH: EHR implementation advice to critical access hospitals from peer experts and other key informants.

Tópicos

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Resumo

LABELLED: The US government allocated $30 billion to implement electronic health records (EHRs) in hospitals and provider practices through policy addressing Meaningful Use (MU). Most small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known about implementation in this setting. Socio-technical factors differ between larger hospitals and CAHs, which continue to lag behind other hospitals in EHR adoption.OBJECTIVE: The main objective is to provide EHR implementation advice for CAHs from a spectrum of experts with an emphasis on recommendations from their peers at CAHs that have undertaken the process. The secondary objective is to begin to identify implementation process differences at CAHs v. larger hospitals.METHODS: We interviewed 41 experts, including 16 CAH staff members from EHR teams at 10 CAHs that recently implemented EHRs. We qualitatively analyzed the interviews to ascertain themes and implementation recommendations.RESULTS: Nineteen themes emerged. Under each theme, comments by experts provide in-depth advice on all implementation stages including ongoing optimization and use. We present comments for three top themes as ranked by number of CAH peer experts commenting - EHR System Selection, EHR Team, and Preparatory Work - and for two others, Outside Partners/Resources and Clinical Decision Support (CDS)/Knowledge Management (KM). Comments for remaining themes are included in tables.DISCUSSION: CAH experts rank the themes differently from all experts, a likely indication of the differences between hospitals. Comments for each theme indicate the specific difficulties CAHs encountered. CAH staffs have little or no EHR experience before implementation. A factor across themes is insufficient system and process knowledge, compounded by compressed implementation schedules. Increased, proactive self-education, via available outside partners and information resources, will mitigate difficulties and aid CAHs in meeting increased CDS requirements in MU Stages 2 and 3.

Resumo Limpo

label us govern alloc billion implement electron health record ehr hospit provid practic polici address meaning use mu small rural hospit particular design critic access hospit cah compris near quarter us hospit implement ehr littl known implement set sociotechn factor differ larger hospit cah continu lag behind hospit ehr adoptionobject main object provid ehr implement advic cah spectrum expert emphasi recommend peer cah undertaken process secondari object begin identifi implement process differ cah v larger hospitalsmethod interview expert includ cah staff member ehr team cah recent implement ehr qualit analyz interview ascertain theme implement recommendationsresult nineteen theme emerg theme comment expert provid indepth advic implement stage includ ongo optim use present comment three top theme rank number cah peer expert comment ehr system select ehr team preparatori work two other outsid partnersresourc clinic decis support cdsknowledg manag km comment remain theme includ tablesdiscuss cah expert rank theme differ expert like indic differ hospit comment theme indic specif difficulti cah encount cah staff littl ehr experi implement factor across theme insuffici system process knowledg compound compress implement schedul increas proactiv selfeduc via avail outsid partner inform resourc will mitig difficulti aid cah meet increas cds requir mu stage

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