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A review of lessons from past EMMER/COPE successes and failures demonstrates two factors commonly observed in implementations that achieve positive (versus negative) outcomes: 1) designing a system that is usable by clinicians n the clinical work context, and 2) adequately preparing users to adopt changes associated with the implementation. Based on this, a framework for User-centered Implementation (GUCCI) is presented.
This framework combines methods from user- centered design and change management to provide an implementation methodology that addresses these factors during implementation and improves the likelihood that positive outcomes are achieved. Next, this study examines clinician acceptance of an EMMER/COPE system implemented in a pediatric hospital system, Children’s Healthcare of Atlanta (Children’s).
Children’s was selected for this research because they have employed an implementation approach founded in user-centered implementation principles and methods. The study examined physician, nurse, and other staff perceptions about the system’s usefulness (performance expectancy (PEE)) implementation. The pre- and post-implementation models demonstrate that the factors that influence PEE change over time. Compatibility with work practices was important both prior to and following implementation.
Prior to implementation, users who perceived a greater need for the system and felt that their needs were represented in the sign process also had xi higher expectations of the impact the system would have on their Job performance. After implementation, PEE ratings were influenced primarily by characteristics of the system. These characteristics included how well the system supported clinical decision making, facilitated sharing information, and how easy it was to use (E).
One aspect of the roll process, the support provided by super users, also had a positive impact on PEE and E after implementation. This finding highlights the importance of having front-line support resources available on the units. Because Children’s employed a GUCCI-based implementation approach, it was expected that good levels of user acceptance of the EMMER/COPE would be achieved. Study results indicate Children’s implementation achieved positive perceptions of system ease of use (E).
However, this ease of use did not consistently translate to favorable ratings of the systems’ impact on individual Job performance. Post-implementation PEE ratings remained neutral or positive for most user subgroups, a finding likely related to the fact that during this intermediate stage of the implementation both the paper hart and EMMER must be used. Managing these dual locations for patient information may be contributing to predominantly neutral, rather than positive, PEE ratings since this limits the ability of the system to contribute to gains in personal efficiency and effectiveness.
The findings on factors that influence PEE and E, two aspects of technology acceptance, and the PEE and E levels achieved with Children’s EMMER were applied to provide further guidance for using GUCCI to achieve clinician acceptance of EMMER systems. Designing EMMER/COPE systems that are usable within the clinical work intent is important because it enables clinicians to focus time and energy on the patient, rather than on using the system. Accomplishing this in practice is difficult given the complexity of these systems and the dynamic clinical care processes they must support.
However, the GUCCI framework presented here can be effectively applied to EMMER/COPE implementations to ensure the usability, utility, and, consequently, acceptance of these systems. INTRODUCTION safety. As a result, many healthcare, government, and business groups are encouraging healthcare providers to adopt EMMER and COPE. For example, in the US the federal government, some state governments, and the Leap Frog Group, a consortium adopting these systems (2003).
These groups advocate adoption of EMMER and COPE because research on adoption of these systems demonstrates a number of benefits associated with their implementation. These benefits, reported in a number of studies and reviews (e. G. , Puissant, Peppier, Tambala, & Kewaskum, 2005; e. G. , Rothschild, 2004; van deer Meijer, Tangent, Troops, & Washman, 2003; Walker & Prophet, 1997), include: Reduction in the incidence of serious medication errors and adverse drug events DADS) Reduced length of patient stay Reduced cost of care (e. . , medication cost) Improved compliance with patient care guidelines Increased completeness and standardization of patient documentation Improved documentation efficiency for nursing staff Improved accessibility to/awareness of/interpretation of patient data (with caution about potential for information overload) Increased time spent with patients Improved communication between departments/professionals Despite some limitations (Berger & Kick, 2004; Orin, Shaffer, & Gullied, 2003;
Rothschild, 2004), the EMMER and COPE literature provides significant evidence of the benefits of implementing these systems. In addition to the reported benefits reviewed previously, these systems provide an infrastructure that truly enables transforming how 1 healthcare is delivered. EMMER/COPE facilitates standardization based on best practice care processes (All et al. , 2005) and COPE has the potential to resolve many current problems in medication prescribing (Shift & Rocker, 1998). For example, Lesser and colleagues (1997) found that the factors most commonly associated with prescribing errors were:
Knowledge and the application of knowledge regarding drug therapy (30%) Knowledge and use of knowledge regarding patient factors that affect drug therapy (29. 2%) Use of calculations, decimal points, or unit and rate expression factors (17. 5%) COPE, especially COPE including dose guideline support, can significantly reduce the potential for all of these factors contributing to errors. Note that while the literature provides evidence of the benefits of EMMER/COPE, these benefits are not reported consistently across all EMMER/COPE implementations.