Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

doi:10.1186/s43058-022-00262-w

. 2022 Feb 2;3(1):10.

doi: 10.1186/s43058-022-00262-w.

Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

Geoffrey D Barnes^{1

2

3}, Emily Sippola⁴, Allison Ranusch⁵, Linda Takamine⁵, Michael Lanham⁶, Michael Dorsch^{7

8}, Anne Sales^{7

5

6}, Jeremy Sussman^{7

5

9}

Affiliations

¹ Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA. gbarnes@umich.edu.
² Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA. gbarnes@umich.edu.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA. gbarnes@umich.edu.
⁴ Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA.
⁵ Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA.
⁶ Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA.
⁷ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
⁸ College of Pharmacy, University of Michigan, Ann Arbor, USA.
⁹ Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.

PMID: 35109916
PMCID: PMC8812192
DOI: 10.1186/s43058-022-00262-w

Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

Geoffrey D Barnes et al. Implement Sci Commun. 2022.

. 2022 Feb 2;3(1):10.

doi: 10.1186/s43058-022-00262-w.

Authors

Geoffrey D Barnes^{1

2

3}, Emily Sippola⁴, Allison Ranusch⁵, Linda Takamine⁵, Michael Lanham⁶, Michael Dorsch^{7

8}, Anne Sales^{7

5

6}, Jeremy Sussman^{7

5

9}

Affiliations

¹ Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, B14 G214, Ann Arbor, MI, 48109-2800, USA. gbarnes@umich.edu.
² Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA. gbarnes@umich.edu.
³ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA. gbarnes@umich.edu.
⁴ Center for Behavioral and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA.
⁵ Center for Clinical Management Research, Ann Arbor Veterans Health Affairs, Ann Arbor, USA.
⁶ Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA.
⁷ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
⁸ College of Pharmacy, University of Michigan, Ann Arbor, USA.
⁹ Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.

PMID: 35109916
PMCID: PMC8812192
DOI: 10.1186/s43058-022-00262-w

Erratum in

Correction: Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process.
Barnes GD, Sippola E, Ranusch A, Takamine L, Lanham M, Dorsch M, Sales A, Sussman J. Barnes GD, et al. Implement Sci Commun. 2023 Mar 13;4(1):25. doi: 10.1186/s43058-023-00412-8. Implement Sci Commun. 2023. PMID: 36915186 Free PMC article. No abstract available.

Abstract

Background: Facilitating appropriate care delivery using electronic health record (digital health) tools is increasing. However, frequently used determinants frameworks seldom address key barriers for technology-associated implementation.

Methods: Semi-structured interviews were conducted in two contexts: the national Veterans Health Affairs (VA) following implementation of an electronic dashboard, a population health tool, and the Michigan Anticoagulation Quality Improvement Initiative (MAQI²) prior to implementation of a similar electronic dashboard. The dashboard is designed for pharmacist or nurse use to monitor safe outpatient anticoagulant prescribing by physicians and other clinicians We performed rapid qualitative inquiry analysis and selected implementation strategies. Through a stakeholder focus group session, we selected implementation strategies to address determinants and facilitate implementation in the MAQI² sites.

Results: Among 45 interviewees (32 in VA, 13 in MAQI²), we identified five key determinants of implementation success: (1) clinician authority and autonomy, (2) clinician self-identity and job satisfaction, (3) documentation and administrative needs, (4) staffing and work schedule, and (5) integration with existing information systems. Key differences between the two contexts included concerns about information technology support and prioritization within MAQI² (prior to implementation) but not VA (after implementation) and concerns about authority and autonomy that differed between the VA (higher baseline levels, more concerns) and MAQI² (lower baseline levels, less concern).

Conclusions: The successful implementation of electronic health record tools requires unique considerations that differ from other types of implementation, must account for the status of implementation, and should address the effects of the tool deployment on clinical staff authority and autonomy. Interviewing both post-implementation and pre-implementation users can provide a robust understanding of implementation determinants.

Keywords: Anticoagulation; Implementation; Pharmacist; Population health.

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Conflict of interest statement

Dr. Barnes discloses consulting fees from Pfizer/Bristol Myers Squibb and Janssen. Dr. Dorsch is supported by R18 HS026874 and R21 HS026322 from the Agency for Health Research and Quality, R01 AG062582 from the National Institutes of Health (NIH)/National Institute of Aging, and the American Health Association Health IT Research Network; has received honoraria from Janssen; and has received research funding from Bristol Myers Squibb/Pfizer and Amgen in the past 2 years. The other authors have no disclosures. The authors declare that Anne Sales is co-Editor-in-Chief of the journal.

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References

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1. Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, et al. Shifting the paradigm: a population health approach to the management of direct oral anticoagulants. J Am Heart Assoc. 2021:e022758 Available from: http://www.ncbi.nlm.nih.gov/pubmed/34796718. - PMC - PubMed
1. Bejjanki H, Mramba LK, Beal SG, Radhakrishnan N, Bishnoi R, Shah C, et al. The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. Clin Outcomes Res. 2018;10:611–618. doi: 10.2147/CEOR.S167499. - DOI - PMC - PubMed
1. Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-Vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17:1467–1507. doi: 10.1093/europace/euv309. - DOI - PubMed
1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ehaa612. - DOI - PubMed

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[1] Austin J, Barras M, Sullivan C. Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record. Int J Med Inform. 2020;135:104066. doi: 10.1016/j.ijmedinf.2019.104066. - DOI - PubMed

[2] Austin J, Barras M, Sullivan C. Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record. Int J Med Inform. 2020;135:104066. doi: 10.1016/j.ijmedinf.2019.104066. - DOI - PubMed

[3] Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, et al. Shifting the paradigm: a population health approach to the management of direct oral anticoagulants. J Am Heart Assoc. 2021:e022758 Available from: http://www.ncbi.nlm.nih.gov/pubmed/34796718. - PMC - PubMed

[4] Allen AL, Lucas J, Parra D, Spoutz P, Kibert JL, Ragheb B, et al. Shifting the paradigm: a population health approach to the management of direct oral anticoagulants. J Am Heart Assoc. 2021:e022758 Available from: http://www.ncbi.nlm.nih.gov/pubmed/34796718. - PMC - PubMed

[5] Bejjanki H, Mramba LK, Beal SG, Radhakrishnan N, Bishnoi R, Shah C, et al. The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. Clin Outcomes Res. 2018;10:611–618. doi: 10.2147/CEOR.S167499. - DOI - PMC - PubMed

[6] Bejjanki H, Mramba LK, Beal SG, Radhakrishnan N, Bishnoi R, Shah C, et al. The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. Clin Outcomes Res. 2018;10:611–618. doi: 10.2147/CEOR.S167499. - DOI - PMC - PubMed

[7] Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-Vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17:1467–1507. doi: 10.1093/europace/euv309. - DOI - PubMed

[8] Heidbuchel H, Verhamme P, Alings M, Antz M, Diener HC, Hacke W, et al. Updated European Heart Rhythm Association Practical Guide on the use of non-Vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace. 2015;17:1467–1507. doi: 10.1093/europace/euv309. - DOI - PubMed

[9] Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ehaa612. - DOI - PubMed

[10] Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) Eur Heart J. 2021;42:373–498. doi: 10.1093/eurheartj/ehaa612. - DOI - PubMed

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Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

Affiliations

Implementing an electronic health record dashboard for safe anticoagulant management: learning from qualitative interviews with existing and potential users to develop an implementation process

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

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References

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