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VA QUERI Informatics Paper

Information Technology for Clinical Guideline Implementation: Perceptions of Multidisciplinary Stakeholders

Affiliations of the authors: University of Iowa College of Nursing (SSL, TT-R), University of Iowa College of Pharmacy (BAS), Iowa City, IA; Drake University College of Pharmacy and Health Sciences, Des Moines, IA (JED); Iowa City Veterans Affairs Medical Center and Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, IA (BJB); Department of Health Management and Policy, The University of Iowa College of Public Health, Iowa City, IA (TEV); Indiana University School of Medicine, Regenstrief Institute for Health Care, and Roudebush VA Medical Center, Indianapolis, IN (BND).

Correspondence and reprints: Toni Tripp-Reimer, PhD, RN, FAAN, The University of Iowa College of Nursing, 406 Nursing Building, Iowa City, IA 52242-1121; e-mail: <toni-reimer{at}uiowa.edu>.

Received for publication: 11/03/03; accepted for publication: 09/01/04.

Objective: This multisite study compared the perceptions of three stakeholder groups regarding information technologies as barriers to and facilitators of clinical practice guidelines (CPGs).

Design: The study settings were 18 U.S. Veterans Affairs Medical Centers. A purposive sample of 322 individuals participated in 50 focus groups segmented by profession and included administrators, physicians, and nurses. Focus group participants were selected based on their knowledge of practice guidelines and involvement in facility-wide guideline implementation.

Measurements: Descriptive content analysis of 1,500 pages of focus group transcripts.

Results: Eighteen themes clustered into four domains. Stakeholders were similar in discussing themes in the computer function domain most frequently but divergent in other domains, with workplace factors more often discussed by administrators, system design issues discussed most by nurses, and personal concerns discussed by physicians and nurses. Physicians and nurses most often discussed barriers, whereas administrators focused most often on facilitation. Facilitators included guideline maintenance and charting formats. Barriers included resources, attitudes, time and workload, computer glitches, computer complaints, data retrieval, and order entry. Themes with dual designations included documentation, patient records, decision support, performance evaluation, CPG implementation, computer literacy, essential data, and computer accessibility.

Conclusion: Stakeholders share many concerns regarding the relationships between information technologies and clinical guideline use. However, administrators, physicians, and nurses hold different opinions about specific facilitators and barriers. Health professionals' disparate perceptions could undermine guideline initiatives. Implementation plans should specifically incorporate actions to address these barriers and enhance the facilitative aspects of information technologies in clinical practice guideline use.

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