The Winchester experience with the TDS hospital information system

Acceptability of medical digital libraries

Evidenced-based medicine has increased the importance of quick accessibility to reputable, upto-date information. Web-accessible digital libraries (DLs) on the wards can address the demand for such information. The use and acceptability of these resources has, however, been lower than expected due to a poor understanding of the context of use. To appreciate the social and organizational impacts of ward-accessible DLs for clinicians, results of a study within a large London-based hospital are presented. In-depth interviews and focus groups with 73 clinicians (from pre-registration nurses to surgeons) were conducted, and the data analysed using the grounded theory method. It was found that clinical social structures interact with inadequate training provision (for senior clinicians), technical support and DL usability to produce a knowledge gap between junior and senior staff, resulting in information – and technology – hoarding behaviours. Findings also detail the perceived effectiveness of traditional and digital libraries and the impact of clinician status on information control and access. One important conclusion is that increased DL usability and adequate support and training for senior clinicians would increase perceptions of DLs as support for, rather than replacement of, their clinical expertise.

Organizational communication and awareness: a novel solution for health informatics

As organizations grow larger and more distributed, the problems of maintaining corporate awareness and effective communication channels escalate. The clinical domain poses particular challenges to maintaining good corporate communications because users have limited time to access information and often have negative technology perceptions. This article highlights how a screen saver application, initially designed to increase privacy and security, developed into a new communication medium improving corporate communication across the organization. An ethnographic study of the application within a hospital setting, analysed using grounded theory methods, details the iterative and organic development of the design through ‘community of practice’ involvement. This application and the evolutionary process through which it was developed were found to not only increase awareness of resources, activities and hospital changes but also positively influence users’ perceptions of, involvement in and ownership of general IT developments. User involvement also raised the importance, for the designers, of application usability, quality and aesthetics.

Requirements of time management tools for outpatient physiotherapy practice

The effects of electronic appointment booking systems on the time management activities of health professionals have received little attention to date. We report on time management practices in three outpatient physiotherapy departments with different paper and electronic systems. The study has identified a set of time management activities and associated social behaviours common to physiotherapy departments. The convenience, flexibility and expressive nature of paper diary systems is of significant value to users, whilst the clarity and superior database functionality of electronic systems are valued by staff using this medium. The study highlights several potential barriers to the effective deployment of electronic booking systems in physiotherapy departments, including poor resource and training provision, concerns regarding restrictive diary control measures, the continued reliance on burdensome duplication procedures and the need to coordinate multiple information artefacts, which need to be addressed if such technology is to be successfully designed and deployed.

Development and initial evaluation of the Clinical Information Systems Success Model (CISSM)

PURPOSE

Most clinical information systems (CIS) today are technically sound, but the number of successful implementations of these systems is low. The purpose of this study was to develop and test a theoretically based integrated CIS Success Model (CISSM) from the nurse perspective.

METHODS

Model predictors of CIS success were taken from existing research on information systems acceptance, user satisfaction, use intention, user behavior and perceptions, as well as clinical research. Data collected online from 234 registered nurses in four hospitals were used to test the model. Each nurse had used the Cerner Power Chart Admission Health Profile for at least 3 months.

RESULTS

Psychometric testing and factor analysis of the 23-item CISSM instrument established its construct validity and reliability. Initial analysis showed nurses' satisfaction with and dependency on CIS use predicted their perceived CIS use Net Benefit. Further analysis identified Social Influence and Facilitating Conditions as other predictors of CIS user Net Benefit. The level of hospital CIS integration may account for the role of CIS Use Dependency in the success of CIS.

CONCLUSIONS

Based on our experience, CISSM provides a formative as well as summative tool for evaluating CIS success from the nurse's perspective.

Comparison of computing capability and information system abilities of state hospitals owned by Ministry of Labor and Social Security and Ministry of Health

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool. The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.

Implementing digital resources for clinicians' and patients' varying needs

This paper presents an overview of several evidence-based medicine and patient information studies conducted across the UK health service over a 4 year period, investigating clinicians', managers', and patients' perceptions of digital resources (primarily digital libraries) in hospitals, Primary Care Trusts, NHS Direct (patient call centre) and patient groups. In-depth interviews and focus groups are analysed using grounded theory methodologies and through content analysis used to produce quantitative finding. The perceived impacts of three different methods employed for delivering health informatics are presented. The findings highlight some generic issues relevant for health informatics in the UK health sector as well as some specific issues for medical digital libraries. This paper reviews in more detail the issues of medical technology implementation (traditional implementation, on the wards, and intermediaries within in communities). A breakdown of the clinicians' and patients' information journey (information initiation, facilitation and interpretation) is also presented with regard to medical digital libraries and online resources. Broad guidelines derived from these findings are provided for health-informatics deployment.

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.

Opportunities for and challenges of computerisation

Information technology offers many potential advantages over paper for the storage and retrieval of patients' data. Enthusiasts predict that soon all records will be stored and viewed on computer, but others are more sceptical. The failure of some computer-based records may be due to poor information design. This paper explores how computers broaden the range of design options but points out that more attention to design is required for computer-based than for paper-based records.