Policy context and digital development: a comparative study of trajectories in 4 Canadian academic health centers over 30 years.

IF 4.7 2区 医学 Q1 COMPUTER SCIENCE, INFORMATION SYSTEMS
Aude Motulsky, Susan Usher, Pascale Lehoux, Catherine Régis, Trish Reay, Paul Hebert, Lise Gauvin, Alain Biron, G Ross Baker, Marie-Pierre Moreault, Johanne Préval, Jean-Louis Denis
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Abstract

Objectives: The digitalization of health records stands to improve decision-making at clinical, administrative, and policy level. Efforts follow various paths and are closely intertwined with health system and organizational configurations. Problems persist in both uptake and use. This study explores the digitalization trajectories of academic health centers (AHCs) to understand tensions between organizational and government strategies and their impact on digital development.

Materials and methods: AHCs play a leadership role within health systems in data-driven improvement. This retrospective case study draws on documentary, observational, and interview data to compare digitalization efforts over 3 decades in 4 AHCs in the province of Quebec (Canada).

Results: At system level, strategy shifted from supporting multilayered development that encouraged bottom-up initiatives in the first decade of the 2000s, to harmonizing clinical information systems in a highly prescriptive manner after 2010. AHCs experienced the shift differently according to concurrent impacts of health system restructuring, and internal choices around electronic health record (EHR) systems and implementation priorities. Digital maturity remained low in all 4 AHCs.

Discussion: Coordination between system strategies and organizational strategies in AHCs was neglected in early digital development in Québec and improved only after an intense period of prescription and resistance. Confrontation highlighted tensions around different objectives at AHC and system level, competing missions within AHCs, and trade-offs between relying on commercial EHRs and developing publicly owned systems, all of which ultimately influence EHR implementation.

Conclusion: The different experiences of focal organizations with digitalization underline the importance of adapting national strategies and providing support to implementers, building on acquired strengths, and arriving at the right balance of guidance from the top and autonomy to develop innovative capacities.

政策背景和数字发展:加拿大4个学术卫生中心30年来发展轨迹的比较研究。
目的:健康记录的数字化有助于改善临床、行政和政策层面的决策。努力遵循各种途径,并与卫生系统和组织结构密切相关。摄取和使用都存在问题。本研究探讨学术医疗中心(AHCs)的数字化轨迹,以了解组织与政府策略之间的紧张关系及其对数字化发展的影响。材料和方法:ahc在数据驱动的改进卫生系统中发挥领导作用。本回顾性案例研究利用文献、观察和访谈数据,比较了魁北克省(加拿大)4家ahc 30年来的数字化工作。结果:在系统层面,战略从本世纪头十年鼓励自下而上的多层次发展转变为2010年后以高度规范的方式协调临床信息系统。根据卫生系统重组的同时影响,以及围绕电子健康记录(EHR)系统的内部选择和实施重点,AHCs经历了不同的转变。在所有4个ahc中,数字成熟度仍然很低。讨论:在曲海的早期数字化发展中,AHCs的系统战略和组织战略之间的协调被忽视,在经历了一段激烈的处方和抵抗期后才得到改善。对抗突出了围绕AHC和系统层面不同目标的紧张关系,AHC内部的竞争任务,以及依赖商业电子病历和开发公有系统之间的权衡,所有这些最终都会影响电子病历的实施。结论:重点组织在数字化方面的不同经验强调了调整国家战略并为实施者提供支持的重要性,建立已获得的优势,并在高层指导和自主之间取得适当平衡,以发展创新能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the American Medical Informatics Association
Journal of the American Medical Informatics Association 医学-计算机:跨学科应用
CiteScore
14.50
自引率
7.80%
发文量
230
审稿时长
3-8 weeks
期刊介绍: JAMIA is AMIA''s premier peer-reviewed journal for biomedical and health informatics. Covering the full spectrum of activities in the field, JAMIA includes informatics articles in the areas of clinical care, clinical research, translational science, implementation science, imaging, education, consumer health, public health, and policy. JAMIA''s articles describe innovative informatics research and systems that help to advance biomedical science and to promote health. Case reports, perspectives and reviews also help readers stay connected with the most important informatics developments in implementation, policy and education.
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