Implementation of a national electronic health record in the specialised setting of neonatal intensive care units

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dc.check.chapterOfThesisAppendix 5 needs to be redacted. The title can remain to guide the reader where to access the content but the report contained in appendix 5 from pages 216-238 needs to be redacted.en
dc.check.date2026-05-31
dc.check.infoPartial Restriction
dc.contributor.advisorGreene, Richard A.
dc.contributor.advisorMurphy, Brendan
dc.contributor.advisorCorcoran, Paul
dc.contributor.authorSheehan, Orla Maria
dc.contributor.funderNational Perinatal Epidemiology Centre
dc.date.accessioned2025-02-10T10:20:25Z
dc.date.available2025-02-10T10:20:25Z
dc.date.issued2024en
dc.date.submitted2024
dc.description.abstractElectronic Health Records (EHRs) are being introduced worldwide and are necessary to update modern healthcare. The introduction of EHRs however is complex and is dependent on a myriad of factors. One key factor in successful EHR implementations is workflows and workflow compliance. Through acceptable workflow designs, clinicians can document appropriate clinical information at source which can be used for clinical decision making and contribute to patient care improvements. In the Republic of Ireland, a national EHR is being introduced for women and their babies- the Maternal and Newborn - Clinical Management System (MN-CMS) EHR provides the research environment for this thesis. This thesis aims to (1) To assess the role workflows play in the successful implementation of an EHR (2) Explore the potential aspects of Implementation Science - using the Normalisation Process Theory (NPT) for evaluation of a successful implementation of an EHR and (3) Can EHR user interfaces be improved with clinician engagement to better facilitate input and management of healthcare data? Primarily quantitative methods, with some qualitative methods, were used for the research contained in this thesis. From exploration of implementation science literature, the Normalisation Process Theory was identified as being useful in complex and technological changes and the various implementation strategies and outcomes are explored. A retrospective document review was undertaken of the MN-CMS Phase One Closure Report to identify the key lessons learned. A retrospective document review was also undertaken to analyse the MN-CMS workflows. The process of workflow design was outlined and evaluated using the AACTT Framework (Actor, Action, Context, Time, Target). Healthcare clinicians (nurses n=76; doctors n=29) workflow compliance was quantifiably measured using background system audit logs and system reports to gain a comprehensive analysis of the workflow compliance. Data were analysed using means and standard deviations. Pre – Post mean differences, and their 95% confidence intervals were calculated and their statistical significant was assessed based on p-values derived from paired t-tests (nurses) and independent t-tests (doctors). The final study of this thesis was improving data quality of newborn feeding in the EHR. Firstly, an expert multidisciplinary group (n=38) were used to design the changes to feeding data entry and review components. Then a quantitative pre-post design was used to assess feeding documentation from newborns electronic records (n= 322). Descriptive statistics and Pearson’s Chi-Square were used to assess pre-post differences and statistical significance. A focus group (n=5) was conducted post implementation and data were analysed using reflexive thematic analysis. This thesis has focused on the Normalisation Process Theory as providing a useful framework for complex changes such as EHR implementation. The use of the AACTT framework is specifically useful in guiding workflow developments. This research has identified key lessons learned and recommendations for a large scale EHR implementation in terms of the planning, implementation and optimisation phases. The key role workflows play in EHR implementation was identified through a retrospective assessment of patient focused workflows from the MN-CMS with modifications and a new workflow successfully implemented using the AACTT framework. Quantifiably measuring workflow compliance identified that the introduction of a new patient summary page demonstrated some very positive changes and adoption of the EHR. Finally, following a collaborative approach to redesigning newborn feeding within an EHR, data completeness significantly improved. This thesis has explored the benefits of the Normalisation Process Theory and the AACTT Framework in implementing EHRs and the key role of workflow development and evaluation. Appropriately designed workflows can underpin the EHR and encourage appropriate and accurate data entry. This thesis has also identified that the EHR system design can be improved with clinician user engagement to improve data input in the EHR.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationSheehan, O. M. 2024. Implementation of a national electronic health record in the specialised setting of neonatal intensive care units. PhD Thesis, University College Cork.
dc.identifier.endpage277
dc.identifier.urihttps://hdl.handle.net/10468/17012
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2024, Orla Maria Sheehan.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectElectronic Health Record
dc.subjectEHR
dc.subjectImplementation
dc.subjectMaternity
dc.subjectNewborn
dc.subjectNeonatal Intensive Care Unit
dc.subjectNICU
dc.subjectWorkflow
dc.subjectWorkflow measurement
dc.subjectImplementation science
dc.subjectNormalisation Process Theory
dc.titleImplementation of a national electronic health record in the specialised setting of neonatal intensive care units
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD - Doctor of Philosophyen
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