Optimising ePrescribing in hospitals through the interoperability of systems and processes: a qualitative study in the UK, US, Norway and the Netherlands

BMC Medical Informatics and Decision Making

Research

Catherine Heeney¹  Matt Bouamrane¹  Aziz Sheikh¹  Kathrin Cresswell¹  Robin Williams²  Stephen Malden³ 

[1] Centre for Medical Informatics, The Usher Institute, The University of Edinburgh Old Medical School Teviot Place Edinburgh, EH8 9AG, Scotland, UK;Institute for the Study of Science, Technology and Innovation, The University of Edinburgh, Edinburgh, Scotland, UK;Usher Institute

[2]  Advanced Care Research Centre (ACRC), Usher Institute

[3]  Advanced Care Research Centre (ACRC), University of Edinburgh, Edinburgh BioQuarter 9 Little France Road, EH16 4UX, Biocubes, Edinburgh, Scotland, UK;

关键词: ePrescribing;    Interoperability;    Integrated system;    Data resources;    Infrastructure;    Electronic health systems;   

DOI  :  10.1186/s12911-023-02316-y

 received in 2022-02-24, accepted in 2023-09-29,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInvestment in the implementation of hospital ePrescribing systems has been a priority in many economically-developed countries in order to modernise the delivery of healthcare. However, maximum gains in the safety, quality and efficiency of care are unlikely to be fully realised unless ePrescribing systems are further optimised in a local context. Typical barriers to optimal use are often encountered in relation to a lack of systemic capacity and preparedness to meet various levels of interoperability requirements, including at the data, systems and services levels. This lack of systemic interoperability may in turn limit the opportunities and benefits potentially arising from implementing novel digital heath systems.MethodsWe undertook n = 54 qualitative interviews with key stakeholders at nine digitally advanced hospital sites across the UK, US, Norway and the Netherlands. We included hospitals featuring ‘standalone, best of breed’ systems, which were interfaced locally, and multi-component and integrated electronic health record enterprise systems. We analysed the data inductively, looking at strategies and constraints for ePrescribing interoperability within and beyond hospital systems.ResultsOur thematic analysis identified 4 main drivers for increasing ePrescribing systems interoperability: (1) improving patient safety (2) improving integration & continuity of care (3) optimising care pathways and providing tailored decision support to meet local and contextualised care priorities and (4) to enable full patient care services interoperability in a variety of settings and contexts. These 4 interoperability dimensions were not always pursued equally at each implementation site, and these were often dependent on the specific national, policy, organisational or technical contexts of the ePrescribing implementations. Safety and efficiency objectives drove optimisation targeted at infrastructure and governance at all levels. Constraints to interoperability came from factors such as legacy systems, but barriers to interoperability of processes came from system capability, hospital policy and staff culture.ConclusionsAchieving interoperability is key in making ePrescribing systems both safe and useable. Data resources exist at macro, meso and micro levels, as do the governance interventions necessary to achieve system interoperability. Strategic objectives, most notably improved safety, often motivated hospitals to push for evolution across the entire data architecture of which they formed a part. However, hospitals negotiated this terrain with varying degrees of centralised coordination. Hospitals were heavily reliant on staff buy-in to ensure that systems interoperability was built upon to achieve effective data sharing and use. Positive outcomes were founded on a culture of agreement about the usefulness of access by stakeholders, including prescribers, policymakers, vendors and lab technicians, which was reflected in an alignment of governance goals with system design.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 4