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Erschienen in: World Journal of Surgery 12/2016

26.07.2016 | Original Scientific Report

Implementation of a Hospital Electronic Surgical Registry in a Lower-Middle-Income Country

verfasst von: Mohini Dasari, Marcelo Garbett, Elizabeth Miller, Gustavo M. Machaín, Juan Carlos Puyana

Erschienen in: World Journal of Surgery | Ausgabe 12/2016

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Abstract

Background

While the benefits of using electronic health records (EHRs) in both developed and low- and middle-income countries are known, the barriers to implementing EHRs in lower-middle-income countries have not been fully characterized. We assessed organizational readiness for implementation of a mobile (tablet-based) EHR, to create a real-time electronic surgical registry, in a busy lower-middle-income country hospital.

Methods

Six semi-structured focus groups were conducted with hospital administrators, faculty surgeons, surgical residents, interns, nurses and medical students in a large urban hospital in Asuncion, Paraguay. Focus groups were conducted over the course of three weeks during the pre-implementation phase to identify barriers to implementation. Focus group data were coded using the Theoretical Domains Framework (TDF), which are 12 validated domains related to behavior change.

Results

Reinforcement, environmental context/resources and roles/responsibilities were the most relevant TDF domains that emerged. Residents and students were more uncertain than faculty and department heads about who would enforce the use of the tool in place of paper charting. Internet quality was a concern raised by all. The local, normative hierarchical structure within the surgical department, including piecemeal communication between the department heads and the residents about roles and responsibilities, was a major perceived barrier to implementation.

Conclusions

Uncertainties about reinforcement, roles and responsibilities for using a novel EHR tool, and technology infrastructure are potential barriers to address in the pre-implementation phase of introducing an EHR to a lower-middle-income country surgical service. Addressing these potential barriers with all stakeholders prior to implementation will be a critical next step in this effort.
Literatur
1.
Zurück zum Zitat Zargaran E, Schuurman N, Nicol AJ et al (2014) The electronic trauma health record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings. J Am Coll Surg 218(1):41–50CrossRefPubMed Zargaran E, Schuurman N, Nicol AJ et al (2014) The electronic trauma health record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings. J Am Coll Surg 218(1):41–50CrossRefPubMed
2.
Zurück zum Zitat Kesinger MR, Nagy LR, Sequeira DJ et al (2014) Standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury 45(9):1350–1354CrossRefPubMed Kesinger MR, Nagy LR, Sequeira DJ et al (2014) Standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury 45(9):1350–1354CrossRefPubMed
4.
Zurück zum Zitat McGinn CA, Grenier S, Duplantie J et al (2011) Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 28(9):46CrossRef McGinn CA, Grenier S, Duplantie J et al (2011) Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 28(9):46CrossRef
5.
Zurück zum Zitat Biruk S, Yilma T, Andualem M et al (2014) Heath professional’s readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study. BMC Med Inform Decis Mak 12(14):155 Biruk S, Yilma T, Andualem M et al (2014) Heath professional’s readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study. BMC Med Inform Decis Mak 12(14):155
6.
Zurück zum Zitat Adams A, Sedalia S, McNab S et al (2015) Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh. Health Policy Plan 31(2):267–275CrossRefPubMed Adams A, Sedalia S, McNab S et al (2015) Lessons learned in using realist evaluation to assess maternal and newborn health programming in rural Bangladesh. Health Policy Plan 31(2):267–275CrossRefPubMed
7.
Zurück zum Zitat Storeng KT, Mishra A (2014) Politics and practices of global health: critical ethnographies of health systems. Glob Public Health. 9(8):858–864CrossRefPubMedPubMedCentral Storeng KT, Mishra A (2014) Politics and practices of global health: critical ethnographies of health systems. Glob Public Health. 9(8):858–864CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behavior change and implementation research. Implement Sci 7:37CrossRefPubMedPubMedCentral Cane J, O’Connor D, Michie S (2012) Validation of the theoretical domains framework for use in behavior change and implementation research. Implement Sci 7:37CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Mirbaha F, Shalviri G, Yazdizadeh B et al (2015) Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Implement Sci 7(10):110CrossRef Mirbaha F, Shalviri G, Yazdizadeh B et al (2015) Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Implement Sci 7(10):110CrossRef
10.
Zurück zum Zitat Stemler S (2001) An overview of content analysis. Pract Assess Res Eval 7(17):137–146 Stemler S (2001) An overview of content analysis. Pract Assess Res Eval 7(17):137–146
11.
12.
Zurück zum Zitat Odero W, Rotich J, Yiannoutsos CT et al (2007) Innovative approaches to application of information technology in disease surveillance and prevention in Western Kenya. J Biomed Inform 40:390–397CrossRefPubMed Odero W, Rotich J, Yiannoutsos CT et al (2007) Innovative approaches to application of information technology in disease surveillance and prevention in Western Kenya. J Biomed Inform 40:390–397CrossRefPubMed
13.
Zurück zum Zitat Schooley B, Walczak S, Hikmet N et al (2016) Impacts of mobile tablet computing on provider productivity, communications, and the process of care. Int J Med Inform 88:62–70CrossRefPubMed Schooley B, Walczak S, Hikmet N et al (2016) Impacts of mobile tablet computing on provider productivity, communications, and the process of care. Int J Med Inform 88:62–70CrossRefPubMed
Metadaten
Titel
Implementation of a Hospital Electronic Surgical Registry in a Lower-Middle-Income Country
verfasst von
Mohini Dasari
Marcelo Garbett
Elizabeth Miller
Gustavo M. Machaín
Juan Carlos Puyana
Publikationsdatum
26.07.2016
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 12/2016
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3654-3

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