Modernizing health information technology: lessons from healthcare delivery systems

Abstract Objective To identify recurrent themes, insights, and process
recommendations from stakeholders in US organizations during the health
information technology (HIT) modernization of an existing electronic
health record (EHR) to a commercial-off-the-shelf product in both
resource-plentiful settings and in a resource-constrained environment, the
US Indian Health Service. Materials and Methods Thirteen qualitative
interviews with stakeholders in various organizations were conducted about
HIT modernization efforts. Using a Theory of Change framework, recurring
themes were identified and analyzed. Results The interviewees emphasized
the importance of organizational and process revision during
modernization, converting historical data, and clinical and leadership
involvement. HIT implementation required technological and infrastructure
redesign, additional training, and workflow reconfiguration. Motivations
for modernization included EHR usability dissatisfaction, revenue
enhancements, and improved clinical operations. Decision-making
strategies, primarily during HIT selection, included meetings with
stakeholders. Successful modernization resulted in improvements in
clinical operations, patient experience, and financial outlay. Discussion
Existing implementation frameworks fail to provide experiential feedback,
such as implementation challenges, like data conversion, regulatory,
functionality, and interoperability requirements. Regardless of the
healthcare environment, HIT modernization requires the engagement of
leadership and end-users during HIT selection and through all stages of
the implementation to prepare people, processes, and technology.
Organizations must iteratively define the technological, infrastructure,
organizational, and workflow changes required for a successful HIT
modernization effort. Conclusions HIT modernization is an opportunity for
organizational and technological change. Successful modernization requires
a comprehensive, intentional, well-communicated, and multidisciplinary
approach. Resource-constrained environments have the additional challenges
of financial burdens, limited staffing, and unstable infrastructure.