A poorly planned health IT implementation can have deleterious effects on the quality of patient care, and can even increase inpatient mortality, according to an article published in the March edition of the American Journal of Managed Care .
Joanne Spetz, PhD, from the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and colleagues identified factors and strategies associated with successful implementation of hospital-based IT systems in the U.S. Department of Veterans Affairs (VA) hospitals and how they might apply to other hospitals.
The researchers held 118 interviews conducted at seven VA hospitals. Focused on the inpatient setting, where nurses are the main patient-care providers, the research emphasized the impact of computerized patient record system (CPRS) and bar code medication administration (BCMA) on nurses. Hospitals were selected to represent a range of IT implementation dates, facility sizes and geography. The subjects included nurses, pharmacists, physicians, IT staff and managers.
Five broad themes arose as factors which affect the process and success of implementation:
- Organizational stability and implementation team leadership;
- Implementation timelines;
- Equipment availability and reliability;
- Staff training; and
- Changes in workflow.
“In the long term, nearly all VA facilities have rectified difficulties they had during implementation, and today, CPRS and BCMA are often credited as being central to the VA’s efforts to achieve high-quality ratings while controlling medical care costs,” the authors found.
Overall IT implementation success in the VA depended on whether there was support for change from both leaders and staff, development of a gradual and flexible implementation approach, allocation of adequate resources for equipment and infrastructure, hands-on support and deployment of additional staff, and how the implementation team planned for setbacks, and continued the process to achieve success.
“Problems that developed in the early stages of implementation tended to become persistent, and poor implementation can lead to patient harm,” they noted.
“Because the VA is an integrated system, computerized patient records can transmit information between physician practices, hospitals, long-term care facilities and other care settings, furthering the benefits of health IT systems,” the authors concluded. “Although the VA may have been the best possible environment for innovations such as CPRS and BCMA, during and after implementation the VA had to overcome many challenges—challenges every facility must address to achieve a successful implementation.”