The enhancement of information systems through user involvement in system design

Factors affecting clinicians' adherence to principles of diagnosis documentation: A concept mapping approach for improved decision-making

BACKGROUND

The quality of data in electronic health records (EHRs) depends on adherence of clinicians to principles of diagnosis documentation.

OBJECTIVE

A concept mapping (CM) approach was used to extract factors related to quality of clinicians' documentation that govern EHR data quality.

METHOD

Influential factors extracted from brainstorming sessions were sorted by individual participants, followed by a quantitative analysis using multidimensional scaling and cluster analysis to categorise sorted factors. Finally, a questionnaire was used to elicit the importance-feasibility of the extracted factors. Results were visualised by cluster maps and Go-Zone plots.

RESULT

Factors were classified into seven clusters: "knowledge about International Classification of Diseases and clinical coding," "need for facilitators and guidelines," "explaining the importance of the issue and defining responsibilities," "cooperation of other personnel," "codify legal requirements," "workload" and "clinical obstacles," as ranked by importance.

CONCLUSION

To enhance the quality of EHR data, a collaboration between physicians, nurses, managers and EHR developers is required. CM is an acceptable approach to meet this objective. Our findings highlight the significance of clinical coding knowledge, awareness about its importance and applicability and use of well-structured information systems. In combination, these three factors can have a strong positive impact on the quality of EHR data.

IMPLICATIONS

A list of solutions is provided for policymakers, and two interventions suggested, based on the findings of this study, including the adoption of EHRs that incorporate documentation guidelines. We further propose updated clinical training programs and a monitoring and feedback mechanism to facilitate the EHR documentation process.

An interpretive approach to the development of patient management information systems

This paper describes the action research process aimed at identifying the information systems requirements of a New Zealand health supplier. In part, this is in response to the recent changes in the New Zealand National Health System and the lack of success of previous implementations of commercial solutions. The study is the product of the urgent necessity of offering better services with more competitive costs, based on the specific requirements of stakeholders (medical, administrative staff). The focus of the requirements is found in the concept of the patient as the generator of the whole system and the centre of information. The creation of a 'Patient Management Information System' (PMIS), and its interaction with different stakeholders, is the recommended outcome of the action research process. The process by which a phased introduction of the PMIS can be implemented, in order to reduce its impact on work practices, is then outlined.