Refereed Studies
From Nhs It Info
Contents |
Evaluating computerised health information systems: hard lessons still to be learnt (Apr 2003)
BMJ 2003;326:860-863
http://www.bmj.com/cgi/content/full/326/7394/860
"Enormous investment has gone into computerised hospital information systems worldwide. The estimated costs for each large hospital are about $50m (£33m), yet the overall benefits and costs of hospital information systems have rarely been assessed. When systems are evaluated, about three quarters are considered to have failed, and there is no evidence that they improve the productivity of health professionals. To generate information that is useful to decision makers, evaluations of hospital information systems need to be multidimensional, covering many aspects beyond technical functionality. A major new information and communication technology initiative in South Africa gave us the opportunity to evaluate the introduction of computerisation into a new environment. We describe how the project and its evaluation were set up and examine where the project went wrong. The lessons learnt are applicable to the installation of all hospital information systems." [Littlejohns, Wyatt and Garvican]
Trusting The Record (2003)
Methods inf. med. 42,4 (2003) pp. 345-352
http://www.dirc.org.uk/publications/articles/papers/81.pdf
". . . The setting for our study is the toxicology ward within a large Edinburgh hospital. The aim was to subject work within the ward, and in particular document work, to close empirical investigation. . . Paper-based records are criticised for being hard to access, poorly organised, incomplete, inaccurate, hard to read, lacking consistency in format and use of terminology. The electronic medical record (EMR) is consequently seen as providing the conditions for the imposition of greater discipline and structure on record-keeping practices and it has also become a major factor in the drive for the standardisation of medical record formats. This standardisation is, in turn, expected to lead to better treatment and the realisation of 'joined-up', 'seamless' healthcare. Our fieldwork data points to a number of trust issues - related to the way that record use is a fundamental aspect of the moral order of the working division of labour . . . Existing patient admission procedures involve the concurrent physical handover of the patient, and of information relating to the patient's admission in the form of the pink and blue sheets. This naturally provides the opportunity not only for the transfer of information about the patient, but also for the checking of its accuracy by the admitting nurse. . . With the deployment of the EMR, future admission procedures might reasonably be expected to dispense with the handover of paper: Ward nurses will be able to access the information recorded at A&E directly through the nurses' station EMR terminal. While this may seem to exemplify the ways in which the EMR can streamline and improve information-handling procedures, we suggest that, in as much as this will decouple the arrival of patient and patient information, it may undermine the robustness and reliability of the process. " [K. Clarke et al]
Supporting Informality: Team Working and Integrated Care Records (2004)
Proc. 2004 ACM Conf. on Computer Supported Cooperative Work (2004) pp.142 - 151
"This paper reports findings from an ethnographic study of the work of Adult and Care of the Elderly Community Mental Health Teams in the context of the deployment of an Electronic Medical Record. Our findings highlight the importance of informal discussions and provisional judgments as part of the process by which teams achieve consensual clinical management decisions over time. . . it would appear that lessons learned from CSCW studies have not, as yet, made a major impact on how large-scale IT systems are designed and implemented. Most work is collaborative, but large-scale IT systems are often poor at supporting the collaborative dimensions of work. . . It would seem that integrated care records systems are, in the main, modelled along the same lines as airline reservation systems - always online, and always up to date. While this model may have its advantages in that it increases organisational control and enables strict auditing (what information was recorded in the system at a particular time and who had access to it), it fails to acknowledge and support the kinds of professional practices we have described. The consequence of this in practice may well be that the system fails to achieve one of its main aims, namely to make more information accessible on time, as people develop practices around the system, committing information to it only once it is 'publication ready'. . ." [G. Hardstone et al]
Who and what are electronic patient records for? (13 Sep 2006)
Proc. Symp, Current Development in Ethnographic Research in the Social and Management Sciences
"[We] report on a field study conducted between 2003 and 2005 at an NHS Trust in the North of England. The choice of case study is interesting because the Trust in question was an 'early adopter'. Before the current version of the NHS IT programme had been announced, the Trust had already signed a contract with an Anglo-American software firm - hereafter 'OurComp' - for them to implement and support a full blown EPR system. The NHS gave them the go-ahead, and so the study provided an opportunity to investigate what some of the issues might be when the larger scale deployment of such systems across England and Wales got underway. . . When the system eventually went live we were lucky enough to observe the first week in the hospital. Unfortunately our concerns were proved valid - the system proved to have multiple problems. Most notably it did not fit well with a number of existing work patterns but to compound this, due it its strict model of governance, when work did not fit with the system the system broke down. . . The unfortunate postscript to this is that after the first week our access was denied as the drama unfolded. It was not particularly unfortunate for us as our project has gone well. However, we do feel very sorry for the members of the project team as it appears that the blame fell as some of their doors even though it was clear from our fieldwork that the system had not failed through lack of skill or effort but rather it had been bound to fail because of the massive ambition for the 'EPR' in general and the way the NHS has conceived of the requirements for such systems. . ." [David Martin]
