Gregory Vial, Aude Motulsky, Mickaël Ringeval, Louis Raymond, Guy Paré
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Analysis yielded twenty-one types of tensions associated with five primary objects: people, power, resources, system, and vision. Twelve tensions were found in multiple cases while fifteen were associated with more than one object.</p><p><strong>Discussion: </strong>Results are aligned with the notion that tensions are inherent to organizational phenomena, showcasing their enduring nature across geographic, temporal, and technological contexts. The diversity of these tensions and their associated object(s) refer to critical, interrelated components of EHR systems implementation that are exacerbated in large-scale projects, and which can affect the implementation across its entire lifecycle.</p><p><strong>Conclusion: </strong>Stakeholders involved in projects to modernize healthcare through the large-scale implementation of EHRs are prone to experience multiple tensions. Attention to the emergence of the tensions identified in this study helps to understand their impacts on projects and stakeholders. Tensions and their associated objects undergird the sociotechnical nature of these complex projects and the need to manage them effectively.</p>","PeriodicalId":50016,"journal":{"name":"Journal of the American Medical Informatics Association","volume":" ","pages":"1241-1253"},"PeriodicalIF":4.6000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199751/pdf/","citationCount":"0","resultStr":"{\"title\":\"Tensions in large-scale electronic health record implementations: insights from a meta-synthesis.\",\"authors\":\"Gregory Vial, Aude Motulsky, Mickaël Ringeval, Louis Raymond, Guy Paré\",\"doi\":\"10.1093/jamia/ocaf088\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To synthesize knowledge on tensions characterizing large-scale electronic health record (EHR) implementations.</p><p><strong>Materials and methods: </strong>A qualitative meta-synthesis was conducted by searching Scopus, Web of Science, MEDLINE, and CINAHL databases to find studies focusing on large-scale EHR implementations in OECD countries. 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引用次数: 0
摘要
目的:综合分析大规模电子健康档案(EHR)实施过程中的紧张关系。材料和方法:通过检索Scopus、Web of Science、MEDLINE和CINAHL数据库进行定性meta综合,以查找有关经合组织国家大规模电子病历实施的研究。完成了一个提取表,以描述病例的关键特征,并根据概念定义在每个研究中提取张力实例。结果:纳入26项定性研究,涵盖11个独特的大型电子病历实施项目。病例分布在欧洲(n = 6)、北美(n = 4)和东南亚(n = 1)。分析得出了21种与5个主要对象相关的紧张关系:人、权力、资源、制度和愿景。在多个病例中发现了12个张力,而15个与多个对象相关。讨论:结果与张力是组织现象固有的概念一致,展示了它们在地理、时间和技术背景下的持久性。这些紧张关系及其相关对象的多样性是指在大型项目中加剧的EHR系统实施的关键的、相互关联的组成部分,并且可能影响其整个生命周期的实施。结论:通过大规模实施电子病历实现医疗现代化项目的利益相关者容易经历多重紧张关系。关注本研究中确定的紧张关系的出现有助于理解它们对项目和利益相关者的影响。紧张关系及其相关对象强化了这些复杂项目的社会技术性质和有效管理它们的需要。
Tensions in large-scale electronic health record implementations: insights from a meta-synthesis.
Objective: To synthesize knowledge on tensions characterizing large-scale electronic health record (EHR) implementations.
Materials and methods: A qualitative meta-synthesis was conducted by searching Scopus, Web of Science, MEDLINE, and CINAHL databases to find studies focusing on large-scale EHR implementations in OECD countries. An extraction table was completed to describe key characteristics of cases, and instances of tensions were extracted within each study based on a conceptual definition.
Results: Twenty-six qualitative studies were included, covering eleven unique large-scale EHR implementation projects. Cases were in Europe (n = 6), North America (n = 4), and Southeast Asia (n = 1). Analysis yielded twenty-one types of tensions associated with five primary objects: people, power, resources, system, and vision. Twelve tensions were found in multiple cases while fifteen were associated with more than one object.
Discussion: Results are aligned with the notion that tensions are inherent to organizational phenomena, showcasing their enduring nature across geographic, temporal, and technological contexts. The diversity of these tensions and their associated object(s) refer to critical, interrelated components of EHR systems implementation that are exacerbated in large-scale projects, and which can affect the implementation across its entire lifecycle.
Conclusion: Stakeholders involved in projects to modernize healthcare through the large-scale implementation of EHRs are prone to experience multiple tensions. Attention to the emergence of the tensions identified in this study helps to understand their impacts on projects and stakeholders. Tensions and their associated objects undergird the sociotechnical nature of these complex projects and the need to manage them effectively.
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.