Barriers to acceptance of EHRs
For this week’s coursework in MI227, we will assume the role of a project manager for a Department of Health (DOH) project with the task of implementing a national Electronic Health Record (EHR) that all government hospitals will implement.
The main objective of the article by Albert Boonstra and Manda Broekhuis was to identify, categorize and analyze the barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) using a systematic literature review method. Among the eight main categories they identified, two – Organizational and Change Process – seemed to be mediating on the other barriers (Financial, Technical, Time, Psychological, Social and Legal). In particular, the change management perspective presents an opportunity to overcome the other barriers and assist in the implementation of EMRs.
The change process means that there will be a major change in the current system. Members of the government hospitals might already have their own system in place that works for them that they have been doing for years. A working electronic information system needs an organization-wide use of the new EHR in order to help all members be more accepting of the change process involved in using the EHR. Organizational support may be bolstered by incentives and the promotion of participation. If I were a project manager, I would first seek the “buy-in” of management in the promotion of an EHR system. I will also request the need for a team within the organization to promote the EHR within the organization. I will also request for approval for the use of incentives. For example, departments which actively use the EHR system may receive financial bonuses or the training sessions may come with company sponsored meals. One thing to consider is whether repercussions may be used to discourage absences from training sessions. Lastly, I would seek to engage “EHR Champions” who will be early adopters of the technology and will cascade the information down to their teams. These EHR Champions will be those who have influence within their teams and may be able to motivate others to adopt the EHR system.
As a Project Manager, I will also look at the organizational size and type of my organization in coming up with a strategy or plan for the EHR adoption. According to Boonstra and Broekhuis, larger practices have a higher EMR adoption rate than those in smaller practices because in larger practices, physicians have more extensive support and training systems. If my target government hospital were a small one, I would need to explore ways to give extensive support and training regardless of size. This may mean requiring the EHR provider to be on call for the support and training that will be needed. This may also mean hiring a full time technical support or officer to assist the personnel during the transition and afterwards.
The other barriers – Financial, Technical, Time, Psychological, Social and Legal – may be dealt with through a well-designed change management strategy and with full organizational support. Financial barriers in government hospitals may be overcome by getting the support of the board or management to seek additional funding or allocating resources. Technical barriers may be managed by putting in place the human resources who will train and support health personnel. Time, psychological and social barriers may be overcome by promoting a change culture. Legal barriers, particularly privacy or security concerns, may be overcome by putting in place the proper safeguards and ensuring that health personnel are adequately trained.
In sum, as a project manager, I will need to engage different stakeholders – management, my team, EMR providers and EHR champions – in the change management strategy. It is with their active participation and support that an EHR system can be fully and successfully implemented.
Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Services Research.
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