In the research article by Boonstra and Broekuis, Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. The writers mentioned, 32 barriers under 7 categories. Amongst the mentioned barriers, as a Project Manager, there are risks that as a part of a team, can already be managed with good planning.
A. Financial (4)
a. High start-up costs
b. High ongoing costs
c. Uncertainty over ROI
d. Lack of financial resources
B. Technical (8)
a. Physician and/or staff lack computer skills
b. Lack of technical training and support
c. Complexity of the System
d. Limitations of the system
e. Lack of customizability
f. Lack of reliability
g. Interconnectivity/Standardization
h. Lack of computers/hardware
C. Time (5)
a. Time required to select, purchase and implement the system
b. Time to learn the system
c. Time required to enter data
d. More time per patient
e. Time to convert patient records
D. Psyschological (2)
a. Lack of belief in EMR
b. Need for control
E. Social (5)
a. Uncertainty about the vendor
b. Lack of support from external parties *
c. Interference with doctor-patient relationship *
d. Lack of support from other colleagues
e. Lack of support from the management level
F. Legal (1)
a. Privacy or security concerns
G. Organizational (5)
a. Organizational size
b. Organizational type
c. Lack of support from the organizational culture
d. Lack of incentives
e. Lack of participation
But there are risks/barriers that can be managed when you just (if) you encountered like
· lack of support in external parties,
· interference with doctor-patient relationship
· lack of support from the organizational culture and need for control
The lack of support of external parties is not easy to manage especially if the impact of the change will disrupt their standard operations. The buy-in factor that we or the organization perceive is to far off from the vision of the organization they represent. For example if DOH chose to implement an ICT system to give solution to a need, stakeholders might not support the system like insurance companies. As they may take it as an additional and inessential expense. These group of peole are usually not part of the project management team, since they are not represented in the planning their concerns are not voiced.
According to Lakbala et. al., the lack of support from external parties a factor that influences decisions by physicians on EMR adoption. Furthermore, insurance companies, which work closely with medical practices, lack specific actions and policies to support the use of EMRs. (P. Lakbala)
Another barrier is interference with doctor-patient relationship. Though this barrier is manageable through reminders and through the capacity building exercises. It is easier said than done. When the system is already up and running, the doctor might get overwhelmed during the consultations. The health workers will certainly need time to adjust to the new system. Going live with a new system will need adjustment specially to the end users.
According to an article “Bringing the HER into the Physician-Patient Relationship”, middle-physicians have negative thoughts about HER, he posted very valid concerns by the physicians, like “Will technology interfere with the humanism and patient interactions that form the heart and soul — if not the science — of medical care?” and the patients have their insight as well, "I didn't tell the nurse I was suicidal because she never looked at me when she asked the question. I figured she didn't really care." And "I want to see a different specialist. He just kept his head down typing the whole time. He's a computer doctor, not a real doctor." (Sheehan, 2012)
In Dr. Sheehan’s article, he made a list of to-do’s to approach this barrier. And it takes someone who had negative thought on the use of an EMR to change the attitude of health workers who have concern on doctor-patient relationship.
He said, “ Technology is a tool that I utilize for patient care; it does not and should not replace the fundamentals of patient care, or common sense for that matter. A long and impressive looking office note with no "substance" helps no one. If an acute visit, for example, only needs a short note, I will only free text a short note” (Sheehan, 2012)
“ I try to never complain about the EHR to the patient, and also try to explain and show how the use of the EHR can improve patient care. Getting the patient to look at something on the monitor such as the tracking of blood pressures, for example, is an excellent way to do just that.” (Sheehan, 2012)
Lastly, the lack of support from the organizational culture and need for control. I chose to link these two barriers, as I see it the culture with in the organization and their control over the processes are already established among themselves. Even if there is a buy in with the new system, once it is being implemented the change creates stress to the organization and their control of over the processes is changed or removed.
An organizational culture that fosters leadership and support is a critical factor when it comes to technology adoption. For example, Rogers’ authority innovation-decision model shows that leaders use their authority to enforce change. Peter Senge’s concept of leadership in a learning organization also illustrates how leaders are supposed to steward and teach members, thereby driving adoption. Further, in the innovation adoption literature, characteristics of key organizational actors have been found to be critical in influencing the innovative behavior of people within the organization and thereby their willingness to engage in adoption processes (P. Nambisan, 2013)
Bibliography
A. Boonstra, M. B. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions . Health Services Research .
P. Lakbala, M. L. (n.d.). ctors Affecting Electronic Medical Record Acceptance by Specialist Physicians.
Sheehan, W. (2012, July 23). Bringing the EHR into Physician-Patient Relationship. Retrieved February 22, 2016 from Physicians Practice: Your Practice, Your Way: http://www.physicianspractice.com/ehr/bringing-ehr-physician-patient-relationship
P. Nambisan, G. K. (2013, March). Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives. Interactive Journal of Medical Research .
