Two patient care information systems in the same hospital: beyond technical aspects.

OBJECTIVES: To compare two clinical workstations in one hospital with respect to technical, organizational, cultural and human factors. One clinical workstation was a GUI to the HIS. The other was an electronic patient record for stroke. METHODS: Data were collected by means of in-depth interviews with end-users of both clinical workstations. The interviews were audio taped and transcribed for analysis. RESULTS: End users assessed both clinical workstations as user friendly. Coordination between health care workers was perceived to be enhanced. However, in both situations poor communication between management, implementers and users resulted in uncertainty and skepticism about future perspectives. Further-more, it appeared that inpatient and outpatient settings needed clinical workstations with different requirements for an optimal fit between work practices and information system. CONCLUSIONS: Regardless of the domain and content of a workstation, it can support coordination between disciplines. The communication concerning the information technology strategy deserves much attention. Finally, the requirements for inpatient and outpatient workstations differ.

Determinants of success of inpatient clinical information systems: a literature review.

We reviewed the English and Dutch literature on evaluations of patient care information systems that require data entry by health care professionals published from 1991 to 2001. Our objectives were to identify attributes that were used to assess the success of such systems and to test the ability of a framework developed by Delone and McLean for management information systems(1) to categorize these attributes correctly. The framework includes six dimensions or success factors: system quality, information quality, usage, user satisfaction, individual impact, and organizational impact. Thirty-three papers were selected for complete review. Types of study design included descriptive, correlational, comparative, and case studies. A variety of relevant attributes could be assigned to the six dimensions in the Delone and McLean framework, but some attributes, predominantly in cases of failure, did not fit any of the categories. They related to contingent factors, such as organizational culture. Our review points out the need for more thorough evaluations of patient care information systems that look at a wide range of factors that can affect the relative success or failure of these systems.

Development and implementation of an EPR: how to encourage the user.

This paper reports on the role users played in the design and development of an electronic patient record. Two key users participated in the project team. All future users received questionnaires and a selection of them was interviewed. Before starting the development of the EPR, the attitude of users towards electronic record keeping, their satisfaction with the paper clinical records, their knowledge of computers, and their needs and expectations of computer applications in health care were measured by means of a questionnaire. The results of the questionnaire were supplemented with in-depth interviews. Users had a neutral attitude towards electronic record keeping. They were more positive about data entry of the paper records than data retrieval. During the development phase, but prior to the implementation of the EPR, a second questionnaire measured satisfaction with the paper records. Satisfaction appeared to be related to self-rated computer experience. Inexperienced computer users tended to be more positive about the paper records. In general, respondents did not have many expectations about electronic record keeping. A second series of interviews zoomed in on the expectations users had. Except for more concise reporting no beneficial effects of electronic record keeping were expected.

An experimental electronic patient record for stroke patients. Part 1: situation analysis.

In this article the paper record and its position in work practices is discussed, and is related to the situation at an inpatient clinic for which an electronic patient record (EPR) is in development. In addition reported research on innovations is discussed. An analysis of 42 clinical paper records gave insight into existing problems with paper records. The current work practices were analysed based on two periods of observations in the ward and eight in-depth interviews with questions about their daily work, communication in the ward and the role of the paper record in communication. The results indicate that several problems described in the literature were recognised only for a part of the medical and nursing records. One probable cause of insufficient communication between health care workers appeared to be the internal organisation of the paper records. The fact that the experimental EPR system will be small-scaled, introduces specific problems regarding communication with other departments that still work with paper records. Nevertheless, we conclude that also an electronic patient record designed for a specific setting has the potential to improve record keeping and communication between health care workers.

An experimental electronic patient record for stroke patients. Part 2: system description.

This article presents an electronic patient record (EPR) for stroke patients. At the neurology department of the Maastricht University Hospital, coordination and communication of the multidisciplinary team for stroke patients is intended to be supported by an EPR. Existing, structured, paper nursing and medical records served as a starting point for the development of the EPR. In close cooperation with future users, the database structure, and data entry and data retrieval aspects of the user interface were adapted to the domain of stroke. The result is a combined electronic medical and nursing record that has potential to improve record keeping and to truly support daily routines. The challenges encountered in the development process were maintaining continuous user involvement and conflicting points of view regarding the relevance of clinical data. Conclusively, we state that intensive user participation improved the EPR, coupling with the existing hospital information system and other systems will be advantageous and the fact that the paper records were structured in advance will smooth the unavoidable changes in work patterns.

The user in the design process of an EPR.

To optimise the development and implementation process of an electronic patient record, attitudes toward computers in health care and satisfaction with paper records of nurses and physicians of a department in an academic hospital were determined. For this purpose participants received two questionnaires. These results were supplemented with eight semi-structured in-depth interviews. Users who considered themselves as experienced computer users had more positive attitudes. Inexperienced users were more satisfied with the nursing paper record, while no significant differences existed for the paper medical record.

An experimental electronic patient record for stroke patients.

This contribution describes an electronic patient record for stroke patients at the neurology ward of the Maastricht University Hospital. Daily practice at the ward will be supported with the developed electronic patient record that integrates both the medical and the nursing record, that will provide decision support and it will be connected to the hospital information system. In an evaluation project we will study the effects of the usage of the electronic patient record and additional effects of providing decision support.