Prioritizing barriers to successful implementation of hospital information systems

Improve the satisfaction of medical staff on the use of home nursing mobile APP by using a hybrid multi-standard decision model

OBJECTIVE

To identify critical satisfaction gaps in a home nursing mobile application (APP) using a systematic decision-making model.

METHODS

Initially, the decision-making trial and evaluation laboratory method was used to analyze the relationship structure and corresponding weights among the indicators. The Importance-Performance Analysis (IPA) method was used to identify the categories of all indicators and their corresponding strategic directions. Twenty-six home nursing specialists currently providing home nursing services were recruited for this study.

RESULTS

The IPA results revealed that "Assurance," "Reliability," and "Personal security protection" are critical satisfaction gaps. From the influence network and weight results, "information quality" and "system quality" were the critical quality factors in the home nursing mobile APP. The influence of the network relationship structure and weight demonstrated a 98.12% significance level, indicating good stability.

CONCLUSION

Continuous improvement in information and system quality is recommended to optimize the overall quality of the home nursing mobile APP. Additionally, user demands should be considered, and personal safety guarantee functions should be developed and integrated into the system to ensure the safety of home nursing workers.

Revolutionizing decision support: a systematic literature review of contextual implementation models for electronic health records systems

PURPOSE

This study aims to assess previously developed Electronic Health Records System (EHRS) implementation models and identify successful models for decision support.

DESIGN/METHODOLOGY/APPROACH

A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources used were Scopus, PubMed and Google Scholar. The review identified peer-reviewed papers published in the English Language from January 2010 to April 2023, targeting well-defined implementation of EHRS with decision-support capabilities in healthcare. To comprehensively address the research question, we ensured that all potential sources of evidence were considered, and quantitative and qualitative studies reporting primary data and systematic review studies that directly addressed the research question were included in the review. By including these studies in our analysis, we aimed to provide a more thorough and reliable evaluation of the available evidence.

FINDINGS

The findings suggest that the success of EHRS implementation is determined by organizational and human factors rather than technical factors alone. Successful implementation is dependent on a suitable implementation framework and management of EHRS. The review identified the capabilities of Clinical Decision Support (CDS) tools as essential in the effectiveness of EHRS in supporting decision-making.

ORIGINALITY/VALUE

This study contributes to the existing literature on EHRS implementation models and identifies successful models for decision support. The findings can inform future implementations and guide decision-making in healthcare facilities.

Building Smart Contracts for COVID19 Pandemic Over the Blockchain Emerging Technologies

This research aims to improve and integrate hospital's healthcare applications with Blockchain and smart contracts technologies to provide huge and secure storage that is immutable. This application will be able to record the patients' medical history like appointments, medical tests, etc.; As a matter of fact, these resources should be recorded to be securely retrieved, modified, and stored by an authorized party only. The utilization of these critical resources will increase the validity for participants with a high level of liability, where building a scheduling appointment system using the blockchain-based on a smart contract will enhance patients' privacy and provides a safer method to keep data away from altering through an unofficial use. COVID-19 Coronavirus is a global disaster that requires a reliable and stable network-based application with a giant and secure platform to hold a huge number of people and settings. The simulated outcomes of the developed system were significant and extremely noteworthy according to immutability and correctness.

Affecting factors of cloud computing adoption in public hospitals affiliated with Zahedan University of Medical Sciences: A cross-sectional study in the Southeast of Iran

Objective

Health care organizations require cloud computing to remain efficient and cost-effective, and provide high-quality health care services. Adoption of this technology by users plays a critical role in the success of its application. This study aimed to determine factors affecting cloud computing adoption in public hospitals affiliated with Zahedan University of Medical Sciences.

Methods

A cross-sectional descriptive and analytic study was performed in 2017. The study population comprised information technology and hospital information system authorities and hospital information system users. The sample consisted of 573 participants. The data were collected using a questionnaire and analyzed with the Statistical Package for Social Sciences software using descriptive and analytical statistics.

Results

The mean score of environmental, human, organizational, technological, and intention dimensions of cloud computing adoption was 3.39 ± 0.81, 3.27 ± 0.63, 3.19 ± 0.71, 3 ± 0.43, and 3.55 ± 1.10, respectively. Furthermore, a significant positive relationship was found between intention of cloud computing adoption and environmental (R = 0.521, p = 0.000), organizational (R = 0.426, p = 0.000), human (R = 0.492, p = 0.000), and technological dimensions (R = 0.157, p = 0.000).

Conclusions

Benefits of cloud computing adoption, relative advantage, and competitive pressure were identified as the most influential factors in accepting cloud computing. Simplifying the users’ understanding of this technology and its application, improving the staff's technical capabilities, promoting executive managers’ understanding of the nature and functions of cloud computing, and fully supporting and increasing governmental mandates for adoption of new technologies are necessary for facilitating the adoption of cloud computing in given hospitals.

Systematic review and policy dialogue to determine challenges in evidence-informed health policy-making: findings of the SASHA study

Background

Various interventions have been undertaken in Iran to promote evidence-informed health policy-making (EIHP). Identifying the challenges in EIHP is the first step toward strengthening EIHP in each country through the design of tailored interventions. Therefore, the current study was conducted to synthesize the results of earlier studies and to finalize the list of barriers to EIHP in Iran.

Methods

To identify the barriers to EIHP in Iran, two steps were taken: a systematic review and policy dialogue. To conduct the systematic review, three Iranian databases and PubMed, Health Systems Evidence (HSE), Embase, and Scopus were searched. The reference lists of included papers and documentation from some local organizations were hand-searched. Upon conducting the systematic review, given the significance of stakeholders in clarifying the problem of EIHP, policy dialogue was used to complete the list previously extracted and to do advocacy. Selection criteria for the stakeholders included influential and informed individuals from knowledge-producing, knowledge-utilizing, and knowledge-brokering organizations. Semi-structured interviews were held with three important absent stakeholders.

Results

Challenges specific to Iran that were identified included the lack of integration of the health ministry and the medical universities, lack of ties between health knowledge utilization organizations, failure to establish long-term research plans, neglect of national research needs at the time of recruiting human resources in knowledge-producing organizations, and duplication and lack of coordination in routine data obtained from surveillance systems, disease registration systems, and censuses. It seems that some challenges are common across countries, including neglecting the importance of inter- and intra-disciplinary studies, the capacity of policy-makers and managers to utilize evidence, the criteria for evaluating the performance of policy-makers, managers, and academic members, the absence of long-term programmes in knowledge-utilizing organizations, the rapid replacement of policy-makers and managers, and lack of use of evaluation studies.

Conclusions

In this study, we tried to identify the challenges regarding EIHP in Iran using a systematic review and policy dialogue approach. This is the first step toward determining the best interventions to improve evidence-informed policy-making in each country, because these challenges are contextual and need to be investigated contextually.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00717-x.

Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review

The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.

Challenges of Implementing Picture Archiving and Communication System in Multiple Hospitals: Perspectives of Involved Staff and Users

Today, despite the advantages of the PACS system, its implementation in some healthcare organizations faces many challenges. One of the important factors in the successful implementation of a PACS system is identifying and prioritizing the challenges from the perspectives of involved staff and user of this system. Therefore, the aim of this study was to determine and compare the challenges of implementing PACS from perspectives these users in educational hospitals. This study was conducted on all IT and medical equipment staff, and radiology residents (n = 140) in Kerman University of Medical Sciences (KUMS) and Shiraz University of Medical Sciences (SUMS) in 2016. The data were collected through two researcher-made questionnaires. Their validity was approved by radiologists, IT staff, and medical informatics specialists and their reliability through calculation of Cronbach's Alpha (0.969 and 0.795). We used Multivariate Analysis of Variance (MANOVA) to compare the scores given by three groups of participants in the challenges and Univariate Analysis of Variance (ANOVA) to compare the scores in two universities. The participants believed that technical challenges were more important than other challenges (x̄=3.74, SD = 0.7). IT experts (x̄=3.87, SD = 1) and radiology residents (x̄=3.95, SD = 0.9) gave the higher scores to the "shortage of high quality monitors" factor and medical equipment experts (x̄=4.26, SD = 0.87) to the "low speed of communication networks" factor among all technical challenges. The mean scores given to technical (x̄=76.1, SD = 13.5) and managerial (x̄=16, SD = 5.9) challenges in SUMS were more than the scores of the same challenges in KUMS (x̄=69.9, SD = 15.7) and (x̄=11.9, SD = 6.4) (p < 0.05). The technical challenges are the most common challenges to PACS implementation, and different universities experience different levels of technical challenges. Eliminating implementation challenges can reduce the risk of failure in the utilization process. Based on the results of this study, providing necessary infrastructures such as appropriate monitors and upgraded IT equipment can prevent many of the PACS implementation challenges.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Usability Evaluation of Three Admission and Medical Records Subsystems Integrated into Nationwide Hospital Information Systems: Heuristic Evaluation

Introduction:

Usability is one of the quality criteria for information systems and its weakness is one of the main barriers to the adoption of these systems. The purpose of this study was to evaluate the usability of admission and medical records module of three widely used hospital information systems (HISs).

Methods:

In this descriptive study the usability of admission and medical records module of three HISs (HIS1, HIS2, and HIS3) was evaluated using heuristic evaluation method. For each HIS, three expert users of the same system assessed the user interface independently, completed a usability evaluation checklist, and rated severity of each identified problem. The checklist was based on Nielsen’s heuristics. For each HIS, three heuristics that have the highest and lowest problem rates and greatest severity of problems were categorized into three separate groups. The results were analyzed using descriptive statistics.

Results:

Although HIS1 and HIS2 were used in more hospitals than HIS3, the results showed that the usability problem rates of them were significantly higher than HIS3. The heuristics of “help and documentation”, “flexibility and efficiency of use”, and “visibility of system status” in the three HISs were categorized into the “highest rate of problems”, “lowest rate of problems”, and “highest severity of problems” groups, respectively. The heuristics of “diagnose and recover from errors”, “error prevention”, and “help and documentation” in HIS1 and HIS2 were categorized into the “highest rate of problems” group.

Conclusions:

The results of this study and previous studies show that the most common usability problems with HISs are related to heuristics of “help and documentation”, “error prevention”, and “help users recognize, diagnose and recover from errors.” Also, the large number of hospitals using one HIS does not demonstrate its high usability to others.

Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics

The health care reform initiative led by the Hong Kong government's Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients' health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users' and organizations' needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users' information technology literacy; training and technical support; and social and organizational influences. The factors are interrelated with the others. The adoption factors identified are multifaceted, ranging from technological characteristics, clinician-technology interactions, skills and knowledge, and the user-workflow-technology fit. Other findings, which have been relatively underrepresented in previous studies, contribute unique insights about the influence of work and social environment on the adoption of EMRs, including limited clinic space and the effects of physicians' decision to use the technology on clinical staffs' adoption decisions. Potential strategies to address the concerns, overcome adoption barriers, and define relevant policies are discussed.

Checking the potential shift to perceived usefulness-The analysis of users' response to the updated electronic health record core features

OBJECTIVE

The primary objective of this paper is to identify the main factors which have an impact on the users' attitude towards the functionalities representing the perceived ease of use and to those representing the perceived usefulness. Another objective is to examine whether there occurred a shift towards the perceived usefulness of users' behavior over a period of time. To support these objectives, two different cases are examined - the case in which users are simultaneously offered basic and updated functionalities, and the one in which users are offered a completely new set of features. The results of this study are expected to exert a significant impact on a further development of new software components, as well as the updates of the existing ones.

MATERIAL AND METHODS

As the starting point, there were employed the user behavior indicators defined in similar researches and conducted in the countries with a similar cultural background or with a comparatively similar national healthcare system. What ensued was an updated set of functionalities offered within the electronic health record based medical information system. Instead of the survey being posted, the effects of implanted updates were measured through the analysis of the collected data. The data collected in the Nis Primary and Ambulatory Care Center during a four-year period represented the material used in the research. The obtained records indicating the usage of the initial and updated visit registration form, as well as the usage of the new types of visits, were examined in relation to the technology acceptance model and integrated behavior model.

RESULTS

The response to the initial functionalities, perceived as easy to use, was high as expected since they kept the users in their "comfort zone". As regards the updated features, the ones corresponding to the perceived usefulness, the initial overall acceptance rate was 60%, while the overall increase of their acceptance was around 20%. The overall usage of the newly introduced features was doubled in some cases throughout the four-year period, while some of them were not accepted as expected.

DISCUSSION

Carefully designed additional functionalities, aimed to improve the most common daily activities, have a significant potential to be accepted by the medical professionals. The shift from the perceived ease of use to the perceived usefulness is not uniform, nor is its use in different departments or by the users of the same department. A higher acceptance rate was observed in the departments with more complex administrative procedures, as well as among the users having contacts with more patients and using the system for a longer period.

CONCLUSION

When accepting new features, medical professionals will initially choose the simpler ones with obvious benefits. If the usage of a feature triggers indirect benefits, the number of examined patients is of a crucial importance for the acceptance of that feature. In the event of the advanced functionality with an extended set of options competing with the simple functionality covering basic requirements, the latter will be used. A feature design, together with a proper training, system stability and ensuring utilization, represent a key point for increasing the positive impact that the information system can have in many application areas, including the healthcare.

Accepting telemedicine in a circulatory medicine ward in major hospitals in South Korea: patients' and health professionals' perception of real-time electrocardiogram monitoring

Background

South Korean government is currently in progress of expanding the coverage of telemedicine projects as part of an attempt to vitalize service industry, but is facing fierce opposition from KMA. Practice of telemedicine requires sufficient discussions among related parties. Although the participation of medical specialists is important, agreement from the public is essential.

Methods

Three main tertiary care centers in Seoul were selected for data collection. A total of 224 patients (patients n = 180, patient guardian n = 44) and medical professionals (n = 41) were selected using simple random sampling. Mixed method of quantitative survey and qualitative semi-interview was used.

Results

This study analyzed patients’ and medical professionals’ perception about the application of telemedicine in cardiology ward in tertiary care centers to provide baseline data when developing and applying telemedicine services. Results implied high need for encouraging telemedicine projects in order to appeal needs among population by providing experience (p < 0.001) and knowledge (p < 0.001). Other results showed that the need for electrocardiography monitoring was high among not only in remote areas but also in areas close to the capital. 64.52% of all participants thought that telemedicine was needed, and 73.21% of participants were willing to use telemedicine service if provided. Semi-interviews revealed that participants expected more cost and time saving services through remote treatment, by not having to visit long distance hospitals frequently.

Conclusions

Research results oppose Korean Medical Association’s opinion that the population is against enforcing telemedicine related laws. The findings in this study reflect an up-to-date perception of telemedicine among patients and medical professionals in a tertiary care centers’ cardiology ward. Moreover, the study provides a baseline that is needed in order to overcome past failures and to successfully implement telemedicine in South Korea.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3105-y) contains supplementary material, which is available to authorized users.

Comparison of two heuristic evaluation methods for evaluating the usability of health information systems

OBJECTIVES

In addition to following the usual Heuristic Evaluation (HE) method, the usability of health information systems can also be evaluated using a checklist. The objective of this study is to compare the performance of these two methods in identifying usability problems of health information systems.

METHODS

Eight evaluators independently evaluated different parts of a Medical Records Information System using two methods of HE (usual and with a checklist). The two methods were compared in terms of the number of problems identified, problem type, and the severity of identified problems.

RESULTS

In all, 192 usability problems were identified by two methods in the Medical Records Information System. This was significantly higher than the number of usability problems identified by the checklist and usual method (148 and 92, respectively) (p < 0.0001). After removing the duplicates, the difference between the number of unique usability problems identified by the checklist method (n = 100) and usual method (n = 44) was significant (p < 0.0001). Differences between the mean severity of the real usability problems (1.83) and those identified by only one of the methods (usual = 2.05, checklist = 1.74) were significant (p = 0.001).

CONCLUSIONS

This study revealed the potential of the two HE methods for identifying usability problems of health information systems. The results demonstrated that the checklist method had significantly better performance in terms of the number of identified usability problems; however, the performance of the usual method for identifying problems of higher severity was significantly better. Although the checklist method can be more efficient for less experienced evaluators, wherever usability is critical, the checklist should be used with caution in usability evaluations.

Challenges of using Hospital Information Systems by nurses: comparing academic and non-academic hospitals

Background and aim

Hospital Information Systems (HIS) are used for easy access to information, improvement of documentation and reducing errors. Nonetheless, using these systems is faced with some barriers and obstacles. This study identifies the challenges and the obstacles of using these systems in the academic and non-academic hospitals in Kerman.

Methods

This is a cross-sectional study which was carried out in 2015. The statistical population in this study consisted of the nurses who had been working in the academic and non-academic hospitals in Kerman. A questionnaire consisting of two sections was used. The first section consisted of the demographic information of the participants and the second section comprised 34 questions about the challenges of HIS use. Data were analyzed by the descriptive and statistical analysis (t-test, and ANOVA) using SPSS 19 software.

Results

The most common and important challenges in the academic hospitals were about human environment factors, particularly “negative attitude of society toward using HIS”. In the non-academic hospitals, the most common and important challenges were related to human factors, and among them, “no incentive to use system” was the main factor. The results of the t-test method revealed that there was a significant relationship between gender and the mean score of challenges related to the organizational environment category in the academic hospitals and between familiarity with HIS and mean score of human environment factors (p<0.05). The results of the ANOVA test also revealed that the educational degree and work experience in the healthcare environment (years) in the academic hospitals have a significant relationship with the mean score related to the hardware challenges, as well, experience with HIS has a significant relationship, with the mean score related to the human challenges (p<0.05).

Conclusion

The most important challenges in using the information systems are the factors related to the human environment and the human factors. The results of this study can bring a good perspective to the policy makers and the managers regarding obstacles of using HISs from the nurses’ perspective, so that they can solve their problems and can successfully implement these systems.

Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention

BACKGROUND

Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T3 trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED]).

METHODS

A survey was developed based on a literature review and data from a complementary trial to identify the commonly reported barriers for the nine T3 clinical care elements. This was administered via a web-based questionnaire to a purposive sample of Australian multidisciplinary clinicians and managers in acute stroke care. The questionnaire addressed barriers to each of the nine T3 trial clinical care elements. Participants produced two ranked lists: on their perception of: firstly, how influential each barrier was in preventing clinicians from performing the clinical care element (influence attribute); and secondly how difficult the barrier was to overcome (difficulty attribute). The rankings for both influence and difficulty were combined to classify the barriers according to three categories ('least desirable', desirable' or 'most desirable' to target) to assist interpretation.

RESULTS

All invited participants completed the survey; (n = 17; 35% medical, 35% nursing, 18% speech pathology, 12% bed managers). The barriers classified as most desirable to target and overcome were a 'lack of protocols for the management of fever' and 'not enough blood glucose monitoring machines'.

CONCLUSIONS

A structured decision-support procedure has been illustrated and successfully applied to identify and prioritise barriers to target within an implementation intervention. This approach may prove to be a useful in other studies and as an adjunct to undertaking barrier assessments within individual sites when planning implementation interventions.

Implementation and Validation of PACS Integrated Peer Review for Discrepancy Recording of Radiology Reporting

The purpose of this work is to demonstrate the possibility of implementation of a PACS-integrated peer review system based on RADPEER™ classification providing a step-wise implementation plan utilizing features already present in the standard PACS implementation and without the requirement of additional software development. Furthermore, we show the usage and effects of the system during the first 30 months of usage. To allow fast and easy implementation into the daily workflow the key-word feature of the PACS was used. This feature allows to add a key-word to an imaging examination for easy searching in the PACS database (e.g. by entering keywords for different kinds of pathology). For peer review we implemented a keyword structure including a code for each of the existing RADPEER™ scoring language terms and a keyword with the phrase "second reading" followed by the name of the individual radiologist. The use of the short-keys to enter the codes in relation to the peer review was a simple to use solution. During the study 599 reports were peer reviewed. The active participation in this study of the radiologists varies and ranges from 3 to 327 reviews per radiologist. The number of peer review is highest in CT and CR. There are no significant technical obstacles to implement a PACS-integrated RADPEER™ -system based on key-words allowing easy integration of peer review into the daily routine without the requirement of additional software. Peer review implemented in a non-random setting based on relevant priors could already help in increasing the quality of radiological reporting and serve as continuing education among peers. Decisiveness, tact and trust are needed to promote use of the system and collaborative discussion of the results by radiologist.

Evaluating factors associated with implementing evidence-based practice in nursing

RATIONALE, AIMS AND OBJECTIVES

Evidence-based practice (EBP) has emerged as an innovation for quality improvement in health care. Nurses have important role in implementing EBP but they face many challenges in this context. Evaluation of factors influencing implementation of EBP seems necessary. The aims of this study were to examine nurses' attitude towards EBP, their self-efficacy and training needs, as well as supporting factors and barriers for implementing EBP.

METHODS

A cross-sectional study was conducted on 182 nurses from four teaching hospitals in Kerman, Iran. Data were collected using a questionnaire consisting of two main sections; a section to collect socio-demographic information of participants and a section collecting information on five topics (staff's attitude, self-efficacy skills of EBP, supporting factors, barriers and training needs for implementing EBP).

RESULTS

The majority (87.4%) of the nurses had not attended any formal training on EBP and 60% of them were not familiar with the concept of EBP. Nurses' attitude towards EBP was unfavourable (2.57 ± 0.99) and their self-efficacy skills of EBP were poor (2.93 ± 1.06). The most important supporting factor was mentoring by nurses who have adequate EBP experience (3.65 ± 1.17) and the biggest barrier was difficulty judging the quality of research papers and reports (2.46 ± 0.95). There was a moderate demand for training in all areas of EBP (3.62 ± 1.12).

CONCLUSIONS

Nursing care needs to move towards quality improvement using EBP. It is necessary to equip nurses with knowledge and skills required for EBP. Managers should design an appropriate strategic plan by considering supporting factors and barriers for integrating EBP into clinical setting.

Implementation of an Anesthesia Information Management System in an Ambulatory Surgery Center

Anesthesia information management systems (AIMS) are increasingly being implemented throughout the United States. However, little information exists on the implementation process for AIMS within ambulatory surgery centers (ASC). The objectives of this descriptive study are to document: 1) the phases of implementation of an AIMS at an ASC; and 2) lessons learnt from a socio-technical perspective. The ASC, within the Veterans Health Administration (VHA), has hosted an AIMS since 2008. As a quality improvement effort, we implemented a new version of the AIMS. This new version involved fundamental software changes to enhance clinical care such as real-time importing of laboratory data and total hardware exchange. The pre-implementation phase involved coordinated preparation over six months between multiple informatics teams along with local leadership. During this time, we conducted component, integration, and validation testing to ensure correct data flow from medical devices to AIMS and centralized databases. The implementation phase occurred in September 2014 over three days and was successful. Over the next several months, during post-implementation phase, we addressed residual items like latency of the application. Important lessons learnt from the implementation included the utility of partnering early with executive leadership; ensuring end user acceptance of new clinical workflow; continuous testing of data flow; use of a staged rollout; and providing additional personnel throughout implementation. Implementation of an AIMS at an ASC can utilize methods developed for large hospitals. However, issues unique to an ASC such as limited number of support personnel and distinctive workflows must be considered.

Applying Task-Technology Fit Model to the Healthcare Sector: a Case Study of Hospitals' Computed Tomography Patient-Referral Mechanism

With the growth in the number of elderly and people with chronic diseases, the number of hospital services will need to increase in the near future. With myriad of information technologies utilized daily and crucial information-sharing tasks performed at hospitals, understanding the relationship between task performance and information system has become a critical topic. This research explored the resource pooling of hospital management and considered a computed tomography (CT) patient-referral mechanism between two hospitals using the information system theory framework of Task-Technology Fit (TTF) model. The TTF model could be used to assess the 'match' between the task and technology characteristics. The patient-referral process involved an integrated information framework consisting of a hospital information system (HIS), radiology information system (RIS), and picture archiving and communication system (PACS). A formal interview was conducted with the director of the case image center on the applicable characteristics of TTF model. Next, the Icam DEFinition (IDEF0) method was utilized to depict the As-Is and To-Be models for CT patient-referral medical operational processes. Further, the study used the 'leagility' concept to remove non-value-added activities and increase the agility of hospitals. The results indicated that hospital information systems could support the CT patient-referral mechanism, increase hospital performance, reduce patient wait time, and enhance the quality of care for patients.