Addressing complexity when developing an education program for the implementation of a stroke Electronic Medical Record (EMR) enhancement

• Published in: BMC health services research Vol. 23; no. 1; pp. 1 - 1301
• Main Authors: Robertson, Samantha T, Rosbergen, Ingrid C. M, Brauer, Sandra G, Grimley, Rohan S, Burton-Jones, Andrew
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 24-11-2023; BioMed Central; BMC
• Subjects: Care and treatment; Diagnosis; Digital health; Digital intervention; Documentation; E-health; Education; Education and training; Electronic health records; Health services; Hospital; Implementation science; Influence; Intervention; Medical personnel; Medical records; Medical research; NASSS; Professional ethics; Stroke; Stroke (Disease); Study and teaching; Teaching hospitals; Technology Acceptance Model; Training; Australia; Queensland Australia
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-023-10314-z

Abstract
Background
Digital interventions in health services often fail due to an underappreciation of the complexity of the implementation. This study develops an approach to address complexity through an evidenced-based, theory-driven education and implementation program for an Electronic Medical Record (EMR) digital enhancement for acute stroke care.
Methods
An action research approach was used to design, develop, and execute the education and implementation program over several phases, with iterative changes over time. The study involved collaboration with multiple statewide and local key stakeholders and was conducted across two tertiary teaching hospitals and a regional hospital in Australia.
Results
Insights were gained over five phases. Phase 1 involved a review of evidence that supported blended learning strategies for the education and training of staff end-users. In Phase 2, contextual assessment was conducted via observation of study sites, providing awareness of local context variability and insight into key implementation considerations. The Non-adoption, Abandonment, Scale-Up, Spread and Sustainability (NASSS) framework assisted in Phase 3 to identify and manage the key domains of complexity. Phase 4 involved the design of the program which included group-based training and an e-learning package, endorsed and evaluated by key leaders. Throughout implementation in Phase 5, further barriers were identified, and iterative changes were tailored to each context.
Conclusions
The NASSS framework, combined with a multi-phased approach employing blended learning techniques, context evaluations, and iterative modifications, can serve as a model for generating theory-driven and evidence-based education strategies that adresss the complexity of the implementation process and context.