TABLE 4-1 Change Agents and Stakeholders Important to the Implementation of Computer-based Patient Record Systems

Organization

Change Agent/Scope of Influence

Stakeholder

Public Sector

 

 

Agency for Health Care Policy and Research

Yes/national

Yes

Centers for Disease Control

No

Yes

Congress

Yes/national

Yes

Department of Defense

Yes/national

Yes

Department of Veterans Affairs

Yes/national

Yes

Food and Drug Administration

No

Yes

Health Resources and Services Administration

Yes/national

Yes

Health Care Financing

Yes/national

Administration

Yes

National Institutes of Health

No

Yes

National Library of Medicinea

Yes/national

No

State health agencies

Yes/regional

Yes

State legislatures

Yes/regional

Yes

Private Sector

 

 

Computer standards organizations

Yes/national

No

Computer-based patient record vendors

Yes/national

Yes

Health care professionals

Yes/individual

Yes

Joint Commission for Accreditation of Healthcare Organizations

Yes/national

No

Patients

No

Yes

Patient groups

Yes/local to national

Yes

Professional associations

Yes/national

Yes

Professional schools

Yes/regional to national

Yes

Provider institutions

Yes/local

Yes

Researchers

No

Yes

Third-party payers

Yes/local to national

Yes

Universities

Yes/regional to national

Yes

a A specific agency of the National Institutes of Health.

Health Care Professionals and Professional Associations

Health care professionals bear a dual burden: they must learn to use a new technology, and they must change their behavior. Some professionals may view the CPR as a threat to their professional roles and resist implementation of CPR systems through attempts at circumvention or even system sabotage (Dowling, 1987). Alternatively, professionals can support



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