User-Driven Designs in Medical Informatics:Developing and Implementing Support forInter-departmental Coordination of Hospital Work using Electronic Whiteboard

We present an ethnographic study of the organizational aspects of the use of an electronic whiteboard (EW) system implemented in a Danish hospital located in Nykøbing Falster (NFH). The EW system had originally been developed for the emergency department (ED), but had later been extended to the entire hospital, and the study was conducted about 10 months its implementation. The study focuses on coordination regarding inter-departmental ordering of surgical operations via the EW system. The research question asked whether clinicians experienced impacts, and challenges in this respect. The results of the study show that the EW system had been configured, and the use of it organized, in a manner that facilitates support of inter-departmental coordination of work. We identify, describe and discuss the challenges related to the difficulty of accommodating the heterogeneous practices and demonstrate the complexity of organizing cooperative work using artefacts and technology across organizational units

Master of Science

thesisAnnually, 46 million patients, or 37% of patients seen in the emergency department (ED), receive laboratory testing in the U.S.; thus, making efficient lab order and result management critical to improving ED throughput, clinical efficacy, and safety. In order to manage labs and other processes, electronic emergency department tracking systems (EDTS) or electronic whiteboards have evolved features that support clinical, operational, and administrative needs. EDTSs have often augmented manual data entry with interfaces and/or integration with other systems such as registration, laboratory, radiology, and clinical information systems (CIS). One such integration evaluated in this study, EDTS/CIS context sharing, was added to automatically pass all necessary user, patient, and application parameters between the two systems in order to open the CIS lab module for a selected patient when the user is notified in the EDTS that laboratory test results for that patient are available for review. Therefore, context sharing eliminated multiple user steps needed to log-on, search, select, and navigate to the lab viewing module in order to view a patient's lab results. This study evaluates the effects of adding EDTS/CIS context sharing to an EDTS with lab notifications on ED process times. These effects were measured utilizing a pre- and post-intervention design for all ED encounters where specific common labs were resulted. A method of analyzing CIS audit logs in combination with EDTS and laboratory information system timestamps was implemented to measure patient management processes for quality improvement. After adding context sharing to lab notification features, the median interval between the availability of lab results and review of those results by the ordering provider decreased from 22.7 min., by 25% or 5.7 min. (p-value < 0.001), to 17.0 min. However, median time from resulting of labs to patient discharge were essentially unchanged, decreasing from 106.6 min. to 105.0 min. (p-value = 0.080). The proportion of lab results reviewed by physicians in the CIS integrated with the EDTS increased from 66% to 86% after the intervention (p-value < 0.001). EDTS/CIS context sharing and passive lab notification features improved the timeliness and completion of lab result review in the CIS and increased system adoption in this setting. However, reductions in the time intervals to review of lab results in the CIS did not result in an operationally or statistically significant improvement in time to discharge after the availability of results

Examining barriers to healthcare providers’ adoption of a hospital-wide electronic patient journey board

Background: The dynamic environment that characterizes patient care in hospitals requires extensive communication between staff. Electronic status board applications are used to improve the flow of communication in hospitals. To date there has been limited work exploring the adoption of these applications in general acute ward settings. Aim: This study aimed to identify barriers to the adoption of an electronic patient journey board (EPJB)1 application in acute wards of a hospital. Method: Data were collected at a large public teaching hospital in Sydney, Australia. The EPJB was implemented across all hospital wards with the aim of improving multidisciplinary communication in wards. Observations (29.5 h) and contextual interviews (n = 33) with hospital staff were conducted in two acute wards of the hospital. Results: Two manual whiteboards were used on wards, in addition to the EPJB, to compensate for information not being available or accessible on the EPJB. Despite the stated purpose of the EPJB, the tool did not appear to support team communication on wards. Barriers to adoption and optimal use of the EPJB included inappropriate location and configuration of the system, limitations in information timeliness, quality and lack of customisation (for different user groups), inconsistent information updates and the absence of a shared understanding of the purpose of the EPJB among the various user groups. Conclusion: Multiple socio-technical barriers influenced uptake and optimal use of the EPJB by healthcare providers. Engaging users early in the design and implementation of electronic status board applications is required to ensure effective use of these complex interventions on general wards

Effects-Driven IT Improvement: Pursuing local post-implementation opportunities

Many opportunities for benefitting from information technology (IT) are not discovered until IT systems are in operational use. The realization of these benefits depends on local efforts that cannot presume top-management support but must themselves generate the innovation potential necessary to improve system use. To facilitate such local efforts, we propose effects-driven IT improvement. It consists of iteratively specifying, realizing, and evaluating the usage effects pursued with a system. We describe the effects-driven process and illustrate it with three real-world cases. On this basis, we discuss its contributions toward local benefits realization at the post-implementation stage. Our overarching contribution is to provide a means of operationalizing and packaging improvement initiatives in a manner that combines local and lightweight experimentation with the data-driven realization of meaningful effects. The three cases illustrate that the effects-driven process can reopen the window of opportunity for benefits realization, result in learning that calls for respecifying the pursued effect, and render evaluation data almost superfluous because the local actors are confident that the effect is substantial and real. In addition, local initiatives to improve system use may create the momentum, evaluation infrastructure, and benefits documentation necessary to pave the way for further improvements. However, these potentials come with challenges, which we also discus