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Journal of Medical Systems Dec 2016Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health... (Review)
Review
Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.
Topics: Confidentiality; Costs and Cost Analysis; Electronic Health Records; Hospital Administration; Humans; Inservice Training; Time Factors; United States; Workflow
PubMed: 27714560
DOI: 10.1007/s10916-016-0628-9 -
Mayo Clinic Proceedings Sep 2020
Topics: COVID-19; Emergency Service, Hospital; Hospital Administration; Humans
PubMed: 32819741
DOI: 10.1016/j.mayocp.2020.06.005 -
CMAJ : Canadian Medical Association... Nov 1992
Topics: Canada; Education; Hospital Administration; Humans; Societies, Hospital; Textbooks as Topic
PubMed: 1483228
DOI: No ID Found -
Healthcare Policy = Politiques de Sante Sep 2014This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an...
This study aimed to enhance understanding of the dimensions of accountability captured and not captured in acute care hospitals in Ontario, Canada. Based on an Ontario-wide survey and follow-up interviews with three acute care hospitals in the Greater Toronto Area, we found that the two dominant dimensions of hospital accountability being reported are financial and quality performance. These two dimensions drove both internal and external reporting. Hospitals' internal reports typically included performance measures that were required or mandated in external reports. Although respondents saw reporting as a valuable mechanism for hospitals and the health system to monitor and track progress against desired outcomes, multiple challenges with current reporting requirements were communicated, including the following: 58% of survey respondents indicated that performance-reporting resources were insufficient; manual data capture and performance reporting were prevalent, with the majority of hospitals lacking sophisticated tools or technology to effectively capture, analyze and report performance data; hospitals tended to focus on those processes and outcomes with high measurability; and 53% of respondents indicated that valuable cross-system accountability, performance measures or both were not captured by current reporting requirements.
Topics: Accreditation; Critical Care; Financial Management, Hospital; Government Regulation; Health Planning; Health Priorities; Hospital Administration; Humans; Mandatory Reporting; Ontario; Organizational Case Studies; Outcome and Process Assessment, Health Care; Quality Indicators, Health Care; Reimbursement, Incentive; Social Responsibility
PubMed: 25305387
DOI: No ID Found -
PloS One 2022Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related...
Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related organizational and regional differences are lacking in Switzerland. Therefore, the objective of this study was to identify and assess a comprehensive set of hospital attributes in relation to average case-mix adjusted costs of hospitals. Using detailed hospital and patient-level data enriched with regional information, we derived a list of 23 cost predictors, examined how they are associated with costs, each other, and with different hospital types, and identified principal components within them. Our results showed that attributes describing size, complexity, and teaching-intensity of hospitals (number of beds, discharges, departments, and rate of residents) were positively related to costs and showed the largest values in university (i.e., academic teaching) and central general hospitals. Attributes related to rarity and financial risk of patient mix (ratio of rare DRGs, ratio of children, and expected loss potential based on DRG mix) were positively associated with costs and showed the largest values in children's and university hospitals. Attributes characterizing the provision of essential healthcare functions in the service area (ratio of emergency/ ambulance admissions, admissions during weekends/ nights, and admissions from nursing homes) were positively related to costs and showed the largest values in central and regional general hospitals. Regional attributes describing the location of hospitals in large agglomerations (in contrast to smaller agglomerations and rural areas) were positively associated with costs and showed the largest values in university hospitals. Furthermore, the four principal components identified within the hospital attributes fully explained the observed cost variations across different hospital types. These uncovered relationships may serve as a foundation for objectifying discussions about cost-related heterogeneity in Swiss hospitals and support policymakers to include structural characteristics into cost benchmarking and hospital reimbursement.
Topics: Child; Diagnosis-Related Groups; Hospital Administration; Hospital Costs; Hospitals, General; Hospitals, University; Humans; Length of Stay
PubMed: 35176112
DOI: 10.1371/journal.pone.0264212 -
Journal of Health Organization and... Feb 2021Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and...
PURPOSE
Integration, that is, the coordination and alignment of tasks, is widely promoted as a means to improve hospital performance. A previous study examined integration and differentiation, that is, the extent to which tasks are segmented into subsystems, in a hospital's social network. The current study carries this research further, aiming to explain integration and differentiation by studying the rules and coordination mechanisms that agents in a hospital network use.
DESIGN/METHODOLOGY/APPROACH
The current case study deepens the analysis of the social network in a hospital. All planning tasks and tasks for surgery performance were studied, using a naturalistic inquiry approach and a mixed method.
FINDINGS
Of the 314 rules found, 85% predominantly exist in people's minds, 31% are in documents and 7% are in the information system. In the early planning stages for a surgery procedure, mutual adjustment based on hospital-wide rules is dominant. Closer to the day of surgery, local rules are used and open loops are closed through mutual adjustment, thus achieving integration. On the day of surgery, there is mainly standardization of work and output, based on hospital-wide rules. The authors propose topics for future research, focusing on increasing the hospital's robustness and stability.
ORIGINALITY/VALUE
This exploratory case study provides an overview of the rules and coordination mechanisms that are used for organizing hospital-wide logistics for surgery patients. The findings are important for future research on how integration and differentiation are effectively achieved in hospitals.
Topics: Hospital Administration; Hospital Information Systems; Hospitals; Humans
PubMed: 33645173
DOI: 10.1108/JHOM-06-2020-0236 -
British Medical Journal Dec 1967
Topics: Hospital Administration; Medical Staff, Hospital; United Kingdom
PubMed: 6081011
DOI: 10.1136/bmj.4.5582.806-e -
BMJ Open Nov 2018To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.
OBJECTIVE
To assess developments over time in the capture, curation and use of quality and safety information in managing hospital services.
SETTING
Four acute National Health Service hospitals in England.
PARTICIPANTS
111.5 hours of observation of hospital board and directorate meetings, and 72 hours of ward observations. 86 interviews with board level and middle managers and with ward managers and staff.
RESULTS
There were substantial improvements in the quantity and quality of data produced for boards and middle managers between 2013 and 2016, starting from a low base. All four hospitals deployed data warehouses, repositories where datasets from otherwise disparate departmental systems could be managed. Three of them deployed real-time ward management systems, which were used extensively by nurses and other staff.
CONCLUSIONS
The findings, particularly relating to the deployment of real-time ward management systems, are a corrective to the many negative accounts of information technology implementations. The hospital information infrastructures were elements in a wider move, away from a reliance on individual professionals exercising judgements and towards team-based and data-driven approaches to the active management of risks. They were not, though, using their fine-grained data to develop ultrasafe working practices.
Topics: Clinical Governance; England; Governing Board; Hospital Administration; Hospital Information Systems; Humans; Risk Management; State Medicine
PubMed: 30478113
DOI: 10.1136/bmjopen-2018-022921 -
Anaesthesia Jan 1967
Topics: Anesthesiology; Economics, Medical; Hospital Administration; State Medicine; United Kingdom
PubMed: 6016182
DOI: 10.1111/j.1365-2044.1967.tb02688.x -
The American Journal of Managed Care Jan 2019To estimate the relationship between data breaches and hospital advertising expenditures. (Observational Study)
Observational Study
OBJECTIVES
To estimate the relationship between data breaches and hospital advertising expenditures.
STUDY DESIGN
Observational data on hospital expenditures were analyzed using a propensity score-matched regression. The regression was specified as a generalized linear model using a gamma distribution and log link.
METHODS
The study sample included Medicare hospitals captured by a survey of traditional media outlets. Hospitals included were nonfederal acute care inpatient hospitals from 2011 to 2014. Voicetrak provided data on hospital advertising expenditures. The Healthcare Cost Report Information System provided data on hospital characteristics and financial variables. Study groups were matched using observable characteristics, such as revenue, number of beds, discharges, ownership, and teaching status. The study excluded hospitals in Maryland and the US territories for financial reporting consistency. Data breaches included theft, loss, unauthorized access/disclosure, improper disposal, and hacking. Advertising expenditures were collected from media outlets including television, radio, newspapers and business journals, and local magazines in a city/metropolitan area.
RESULTS
Breached hospitals (n = 72) were more likely to be large, teaching, and urban hospitals relative to the control group (unweighted n = 915). A data breach was associated with a 64% (95% CI, 7.2%-252%; P = .023) increase in annual advertising expenditures, holding observable characteristics constant.
CONCLUSIONS
Breached hospitals were associated with significantly higher advertising expenditures in the 2 years after the breach. Efforts to repair the hospital's image and minimize patient loss to competitors are potential drivers of the increased spending. Advertising costs subsequent to a breach are another cost to the healthcare system that could be avoided with better data security.
Topics: Advertising; Computer Security; Hospital Administration; Hospital Bed Capacity; Hospital Costs; Humans; Ownership; Propensity Score; Residence Characteristics; United States
PubMed: 30667613
DOI: No ID Found