A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design

The Key Determinant Factors of Clinical Information Systems User Satisfaction: Lessons Learnt From an Australian Case Study

Driven by the escalating pressures to enhance its outcomes within its limited resources, the healthcare industry is increasingly investing in various clinical information systems. Although user satisfaction is key to realizing the benefits of these large invests, the determinant factors for user satisfaction with clinical information systems are still not well understood. This study addresses this need by qualitatively investigating the relationships between the overall satisfaction with clinical information systems and five key aspects of clinical information systems, namely key functionalities, efficiency of use, intuitiveness of graphical user interfaces (GUI), communication, collaboration, and information exchange, and interoperability and compatibility issues. The findings resulting from both descriptive and thematic analyses show that clinical information systems are still in their infant stage and that their maturity is highly questionable. Simpler clinical information systems are likely to be more satisfying than more complex systems. System design and training provided are also key factors as the study finds

Clinical Information Systems: Their Application in the ICU

journal articleBiomedical Informatic

Bridging clinical information systems and grid middleware: a Medical Data Manager

International audienceThis paper describes the effort to deploy a Medical Data Management service on top of the EGEE grid infrastructure. The most widely accepted medical image stan- dard, DICOM, was developed for fulfilling clinical practice. It is implemented in most medical image acquisition and analysis devices. The EGEE middleware is us- ing the SRM standard for handling grid files. Our prototype is exposing an SRM compliant interface to the grid middleware, transforming on the fly SRM requests into DICOM transactions. The prototype ensures user identification, strict file ac- cess control and data protection through the use of relevant grid services. This Medical Data Manager is easing the access to medical databases needed for many medical data analysis applications deployed today. It offers a high level data man- agement service, compatible with clinical practices, which encourages the migration of medical applications towards grid infrastructures. A limited scale testbed has been deployed as a proof of concept of this new service. The service is expected to be put into production with the next EGEE middleware generation

Clinical information systems in the intensive care unit: primum non nocere

Information and communication technology has the potential to address many problems encountered in intensive care unit (ICU) care, namely managing large amounts of patient and research data and reducing medical errors. The paper by Morrison and colleagues in the previous issue of Critical Care describes the adverse impact of introducing an electronic patient record in the ICU on multi-disciplinary communication during ward rounds. The importance of evaluation and technology assessment in the implementation and use of new computing technology is highlighted

An Organizational Culture-Based Theory of Clinical Information Systems Implementation in Hospitals

We propose an organizational culture-based explanation of the level of difficulty of clinical information system (CIS) implementation and of the practices that can contribute to reduce the level of difficulty of this process. Adopting an analytic induction approach, we developed initial theoretical propositions based on a three-perspective conceptualization of organizational culture: integration, differentiation, and fragmentation. Using data from three cases of CIS implementation, we first performed a deductive analysis to test our propositions on the relationships between culture, CIS characteristics, implementation practices, and the level of implementation difficulty. Then, applying an inductive analysis strategy, we re-analyzed the data and developed new propositions. Our analysis shows that four values play a central role in CIS implementation. Two values, quality of care and efficiency of clinical practices, are key from an integration perspective; two others, professional status/autonomy and medical dominance, are paramount from a differentiation perspective. A fragmentation perspective analysis reveals that hospital users sometimes have ambiguous interpretations of some CIS characteristics and/or implementation practices in terms of their consistency with these four values. Overall, the proposed theory provides a rich explanation of the relationships between CIS characteristics, implementation practices, user values, and the level of difficulty of the implementation process