Effective and feasible interventions to improve structured EHR data registration and exchange: A concept mapping approach and exploration of practical examples in the Netherlands

Background: Data in Electronic Health Records (EHRs) is often poorly structured and standardized, which hampers data reuse. Research described some examples of interventions to increase and improve structured and standardized data, such as guidelines and policies, training and user friendly EHR interfaces. However, little is known about the translation of this knowledge into practical solutions. Our study aimed to specify the most effective and feasible interventions that enable better structured and standardized EHR data registration and described practical examples of successfully implemented interventions. Methods: A concept mapping approach was used to determine feasible interventions that were considered to be effective or have been successfully implemented in Dutch hospitals. A focus group was held with Chief Medical Information Officers and Chief Nursing Information Officers. After interventions were determined, multidimensional scaling and cluster analysis were performed to categorize sorted interventions using Groupwisdom™, an online tool for concept mapping. Results are presented as Go-Zone plots and cluster maps. Following, semi-structured interviews were conducted to describe practical examples of successful interventions. Results: Interventions were classified into seven clusters ranked from highest to lowest perceived effectiveness: (1) education on usefulness and need; (2) strategic and (3) tactical organizational policies; (4) national policy; (5) monitoring and adjusting data (6) structure of and support from the EHR and (7) support in the registration process (EHR independent). Interviewees emphasized the following interventions proven successful in their practice: an enthusiastic ambassador per specialty who is responsible for educating peers by increasing awareness of the direct benefit of structured and standardized data registration; dashboards for continuous feedback on data quality; and EHR functionalities that support (automating) the registration process. Conclusions: Our study provided a list of effective and feasible interventions including practical examples of interventions that have been successful. Organizations should continue to share their best practices to learn from and attempted interventions to prevent implementation of ineffective interventions.