Implementation of Electronic Health Record Systems

Implementation of Electronic Health Record Systems in Physical Therapy Gabriela Postolache1, Isabel Moreira2, Luisa Pedro3, Raul Oliveira4 1Instituto de

Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal Telecomunicações, Lisbon, Portugal 3Escola Superior de Tecnologia de Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal 4Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal 2Instituto de

Introduction Electronic health record’s (EHRs) systems, primarily developed for use in hospital healthcare, have been improving patient care worldwide. The use of EHRs in physical therapy is essential to the effectiveness of their practices. This study aims to understand potential barriers to the implementation and adoption of EHRs in Physical Therapy in Portugal. Methods A systematic review of the literature was accomplished in order to synthesize information on needs, requirements and barriers of adoption of EHRs. Two focus groups were conducted among Portuguese Physical Therapists in order to explore their perspectives regarding the implementation of EHRs in the Physical Therapy context. A structured self-administered questionnaire was designed based on the contents extracted from the review of the literature and the focus groups. Then, 96 Physical Therapists (PT) self-completed the questionnaire using an online platform. Data were analyzed using SPSS software. Results EHRs for Physical Therapy – Qualitative analysis of needs and requirements

Professional Category N %

Genre M N %

F 35 36,5

61 63,5

Percentage

Demographics of Physical Therapists that participated in study

Average Age 35,7±10,7 35,7±9,4 ±SD(Range) (22-60) (23-59)

Institution

PT PT Coord PT Spec PT Princ 1stclass PT 2class Other Public Private Both 13 6 4 6 37 20 19 50 27 13,5 6,3 14,6 6,3 38,5 20,8 19,8 52,1 28,1

90 80 70 60 50 40 30 20 10 0 Inadequacy of ICT to the needs of Physical Therapists

From 22 items that were used in a developed structured questionnaire addressing barriers of the adoption of EHRs in physical therapy, 8 were identified by most of the participants as factors that over difficult the adoption of EHRs in physical therapy: - lack of financial incentive for EHRs implementation in physical therapy - lack of EHRs system developers knowledge on physical therapy processes and workflow - not acceptable technological performance - costs of implementation and maintenance - technologies not addressing tangible and practical needs - regulatory policy, - lack of public institutions’ support for implementation, - lack of cooperation between physical therapists and EHRs system developers .

Costs related with Performance problems Inexperience of the implementation and of ICT users regarding the ICT maintenance of ICT use.

Lack of cooperation between Physical Therapists and ICT developers

Lack of knowledge of EHRs developers on Physical Therapy processes flow

Economic reasons of Lack of financial Authorisation systems Lack of state support healthcare providers support or incentive for on the market, EHRs implementation involving companiesin Physical Therapy prescribers relationship

60,4 % of respondentes indicate having low or lack of knowledge on informatics

Percentage of respondents with lack or low knowledge on informatics reporting lfactors with low or lack of effect

70

Percentage

60 50

Percentage of respondents with lack or low knowledge on informatics reporting factors that in high extent hamper adoption of EHRs in Physical Therapy

40 30 20 10 0 Inadeq_Tecnologies

Costs

System Performance

Patients_Inexperience

Lack of Cooperation

Developers knowledge

Institution Econ Reasons

Financial Incentive

Authorization System

Total of respondents with lack or low knowledge on informatics

State Support

Physical therapists that indicated having good to very good knowledge on informatics scored the barriers of adoption (5 point Likert Scale, 1-no hamper; 5extremely hamper) higher than physical therapists characterized by lack to low level of knowledge on information and communications technology. Complexity of Inadequacy of Knowledge on informatics use Technologies no - low Média 3,28 3,83 N 58 58 Desvio Padrão 1,073 1,078 good - very Média 3,32 3,95 good N 38 38 Desvio Padrão ,962 ,899 Total Média 3,29 3,88 N 96 96 Desvio Padrão 1,025 1,008

Costs 3,81 58 1,034 3,81 37 1,050 3,81 95 1,034

System Performance 3,97 58 ,991 4,00 38 ,959 3,98 96 ,973

Security 2,98 57 1,203 3,24 38 1,261 3,08 95 1,226

Developers Physical Physical knowledge on Therapists Patients Therapists Patients Physical Low evidence resistance to resistance to Inexperience Inexperience Effect on work Effect on Lack of Therapy on change change on ICT on ICT load quality of work Lack of training cooperation processes effectiveness 3,04 3,05 3,31 3,50 3,03 2,21 3,53 3,88 4,07 3,14 57 57 58 58 58 57 58 58 58 58 1,068 1,007 ,842 1,047 ,991 1,130 ,842 ,993 ,989 1,050 3,37 3,29 3,21 3,45 2,89 2,08 3,39 3,76 4,16 3,34 38 38 38 38 38 38 38 37 37 38 1,076 1,113 1,044 1,155 1,060 1,100 1,128 1,140 1,093 ,909 3,17 3,15 3,27 3,48 2,98 2,16 3,48 3,83 4,11 3,22 95 95 96 96 96 95 96 95 95 96 1,078 1,052 ,923 1,086 1,015 1,114 ,962 1,048 1,026 ,997

Patients economic reasons 3,29 58 1,043 3,08 38 1,194 3,21 96 1,104

Healthcare providers economic reasons 4,03 58 ,936 3,82 38 1,111 3,95 96 1,009

Lack of Lack of financial state incentive Regulatory policy support Others 4,19 3,84 3,86 1,00 57 57 58 4 ,833 ,922 1,017 0,000 4,05 3,55 3,65 1,33 38 38 37 3 1,114 1,058 1,160 ,577 4,14 3,73 3,78 1,14 95 95 95 7 ,952 ,983 1,074 ,378

Conclusion Our results suggest that the main barriers of adoption of EHRs in physical therapy were lack of developers’ knowledge on physical therapy processes and workflow and lack of financial incentive for adoption. Physical therapists with information and communication technology literacy can be a facilitator in the implementation of EHRs. The 1st Asia-Oceanian Congress for NeuroRehabilitation, Seoul, Korea, September 3-5 , 2015

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