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Supporting Collaborative Work through ICT: How End-users Think of and Adopt Integrated HealthInformation Systems
Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Health Information Systems (HISs) are implemented to support individuals,organizations, and society, making work processes integrated andcontributing to increase service quality and patient safety. However, theoutcomes of many HIS implementations in both primary care and hospitalsettings have either not met yet all the expectations decision-makersidentified or have failed in their implementation. There is, therefore, agrowing interest in increasing knowledge about prerequisites to be fulfilledin order to make the implementation and adoption of HIS more effective andto improve collaboration between healthcare providers.

The general purpose of the work presented in this thesis is to explore issuesrelated to the implementation, use, and adoption of HISs and its contributionfor improving inter- and intra-organizational collaboration in a healthcarecontext. The studies included have, however, different research objectivesand consequently used different research methods such as case study,literature review, meta-analysis, and surveys. The selection of the researchmethodology has thus depended on the aim of the studies and their expectedresults.

In the first study performed we showed that there is no standard frameworkto evaluate effects and outputs of implementation and use of ICT-basedapplications in the healthcare setting, which makes the comparison ofinternational results not possible yet.

Critical issues, such as techniques employed to teach the staff when usingintegrated system, involvement of the users in the implementation process,and the efficiency of the human computer interface were particularlyreported in the second study included in this thesis. The results of this studyalso indicated that the development of evidence-based implementation processes should be considered in order to diminish unexpected outputs thataffect users, patients and stakeholders.

We learned in the third study, that merely implementing of a HIS will notautomatically increase organizational efficiency. Strategic, tactical, andoperational actions have to be taken into consideration, includingmanagement involvement, integration in healthcare workflow, establishingcompatibility between software and hardware, user involvement, andeducation and training.

When using an Integrated Electronic Prescribing System (IEPS), pharmaciesstaff declared expedited the processing of prescriptions, increased patientsafety, and reduced the risk for prescription errors, as well as the handingover of erroneous medications to patients. However, they stated also that thesystem does not avoid all mistakes or errors and medication errors stilloccur. We documented, however, in general, positive opinions about theIEPS system in the fifth article. The results in this article indicated thatsafety of the system compared to a paper-based one has increased. Theresults showed also an impact on customer relations with the pharmacy; andprevention of errors. However, besides finding an adoption of the IEPS, weidentified a series of undesired and non planned outputs that affect theefficiency and efficacy of use of the system.

Finally, we captured in the sixth study indications for non-optimality in thecomputer provider entry system. This is because; the system was not adaptedto the three-quarters of physicians and one-half of nurses’ specificprofessional practice. Respondents pointed out also human-computerinteraction constrains when using the system. They indicated also the factthat the system could lead to adverse drug events in some circumstances.

The work presented in this thesis contributes to increase knowledge in thearea of health informatics on how ICT supports inter- and intraorganizationalcollaborative work in a healthcare context and to identifyfactors and prerequisites needed to be taken into consideration whenimplementing new generations of HIS.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 61 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 1268
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-20572ISBN: 978-91-7393-550-0 (print)OAI: oai:DiVA.org:liu-20572DiVA: diva2:235178
Public defence
2009-10-09, Planck, Fysikhuset, Campus Valla, Linköpings universitet, Linköping, 10:15 (English)
Opponent
Supervisors
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2013-09-05Bibliographically approved
List of papers
1. Methods to Evaluate Health information Systems in Healthcare Settings: A Literature Review
Open this publication in new window or tab >>Methods to Evaluate Health information Systems in Healthcare Settings: A Literature Review
2007 (English)In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 31, no 5, 397-432 p.Article in journal (Refereed) Published
Abstract [en]

Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system’ productivity and effectiveness.

Place, publisher, year, edition, pages
Springer, 2007
Keyword
Evaluation studies, Medical informatics, Literature review
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:liu:diva-15650 (URN)10.1007/s10916-007-9082-z (DOI)
Available from: 2008-11-26 Created: 2008-11-25 Last updated: 2017-12-14Bibliographically approved
2. Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare
Open this publication in new window or tab >>Implementing an integrated computerized patient record system: Towards an evidence-based information system implementation practice in healthcare
2008 (English)In: AMIA 2008 Annual Symposium, Biomedical and Health Informatics:form foundations to applications to policy. Washington DC. 8-12 November 2008, 2008, 616-620 p.Conference paper, Published paper (Refereed)
Abstract [en]

A large number of health information system (HIS) implementations fail due to insufficient organizational harmonization. The aim of this study is to examine whether these problems remain when implementing technically integrated and more advanced generations of HIS. In a case study, data from observations, interviews, and organizational documents were analyzed using qualitative methods. We found that critical issues in the case study implementation process were the techniques employed to teach the staff to use the integrated system, involvement of the users in the implementation process, and the efficiency of the human computer interface. Comparisons with a literature review showed both recurrence of previously reported implementation problems and new issues specific to the integrated system context. The results indicate that the development of evidence-based implementation processes should be considered.

Series
AMIA Annual Symposium Proceedings, ISSN 1942-597X
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:liu:diva-15672 (URN)
Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2015-05-28Bibliographically approved
3. Health Information System Implementation: A Qualitative Meta-analysis
Open this publication in new window or tab >>Health Information System Implementation: A Qualitative Meta-analysis
2009 (English)In: Journal of medical systems, ISSN 0148-5598, E-ISSN 1573-689X, Vol. 33, no 5, 359-368 p.Article in journal (Refereed) Published
Abstract [en]

Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.

Place, publisher, year, edition, pages
Springer Netherlands, 2009
Keyword
Health information system, Implementation, Qualitative methods, Meta-analysis
National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:liu:diva-15673 (URN)10.1007/s10916-008-9198-9 (DOI)
Note
The original publication is available at www.springerlink.com: Bahlol Rahimi, Vivian Vimarlund and Toomas Timpka, Health Information System Implementation: A Qualitative Meta-analysis, 2009, Journal of medical systems, (33), 5, 359-368. http://dx.doi.org/10.1007/s10916-008-9198-9 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2008-11-26 Created: 2008-11-26 Last updated: 2017-12-14Bibliographically approved
4. Integrated electronic prescribing systems: pharmacists’ perceptions ofimpact on work performance and patient safety
Open this publication in new window or tab >>Integrated electronic prescribing systems: pharmacists’ perceptions ofimpact on work performance and patient safety
2009 (English)In: Proceedings of the 9th WSEAS International Conference on APPLIED INFORMATICS AND COMMUNICATIONS (AIC '09), 2009, 299-304 p.Conference paper, Published paper (Other academic)
Abstract [en]

Integrated electronic prescribing systems (IEPSs) are expected to improve efficiency and safety inthe management of pharmaceuticals throughout the healthcare sector. We examined the introduction of anIEPS into pharmacists’ work performance with regard to impact on efficiency and patient safety. Aquestionnaire was distributed to all pharmacists (n = 85) in a Swedish municipality (pop. 145,000) where anIEPS had recently been introduced. The response rate was 74%. We found that, in general, the IEPS wasperceived to have expedited the processing of prescriptions and reduced the risk for prescription errors, as wellas the handing over of erroneous medications to patients. Pharmacists were more cautious about the residualrisks for making mistakes than the pharmacist’s assistants. We conclude that the introduction of an IEPS waswell received by local-level pharmacy staff, but that an IEPS does not automatically reduce the need forqualified personnel in the management of pharmaceuticals.

Keyword
Electronic prescribing, pharmacist, patient safety, work performance
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-20568 (URN)000273271800052 ()978-960-474-107-6 (ISBN)
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2013-09-05Bibliographically approved
5. Introduction of an Integrated ElectronicPrescribing System: The Pharmacies StaffDimension
Open this publication in new window or tab >>Introduction of an Integrated ElectronicPrescribing System: The Pharmacies StaffDimension
2009 (English)In: The 14th International Symposium for Health Information ManagementResearch (ISHIMR), Kalmar, Sweden, 14-16 October, 2009Conference paper, Published paper (Other academic)
Abstract [en]

An integrated electronic prescribing system allows the transfer of pharmaceutical prescriptionsfrom doctors to pharmacies. Using a questionnaire, we gathered data from the pharmacies staffin a Swedish county council. We found that most of the pharmacists have positive opinions aboutthe system. The participants in the survey indicated, as important issues, the safety of the systemcompared to a paper-based one; impact on customer relations with the pharmacy; and preventionof errors. However, it was stated that errors occur due to similar drug names, codes, or due theinability of doctors to cancel the prescription once it is send to the pharmacy. Future feasibility ofthis technology will be determined by whether several obstacles can be resolved such ascorrection or cancellation of prescriptions by physicians, decreasing the computer problems, andattending different risks related to the prescriptions including confusion between different patientsand different drugs.

Keyword
Electronic prescribing, pharmacists, patient safety, work process
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-20570 (URN)
Available from: 2009-09-14 Created: 2009-09-14 Last updated: 2009-09-14Bibliographically approved
6. Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory
Open this publication in new window or tab >>Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory
Show others...
2009 (English)In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 52Article in journal (Refereed) Published
Abstract [en]

Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods: The diffusion of innovation theory was used to understand physicians and nurses attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P andlt; 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = andlt; 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P andlt; 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P andlt; 0.001). Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e. g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53838 (URN)10.1186/1472-6947-9-52 (DOI)000273910200001 ()
Note
Original Publication: Bahlol Rahimi, Toomas Timpka, Vivian Vimarlund, Srinivas Uppugunduri and Mikael Svensson, Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory, 2009, BMC MEDICAL INFORMATICS AND DECISION MAKING, (9), 52, . http://dx.doi.org/10.1186/1472-6947-9-52 Licensee: BioMed Central http://www.biomedcentral.com/. On the day of the defence date the original title of this article was "Adoption of computerized provider order entry systems: An organization-wide study based on diffusion of innovations theory".Available from: 2010-02-05 Created: 2010-02-05 Last updated: 2017-12-12Bibliographically approved

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