SLIDE 1 Clinician reports of the impact
- f electronic ordering on an
Emergency Department
Andrew Georgiou (Senior Research Fellow) Johanna I Westbrook (Professor and Director)
Health Informatics Research & Evaluation Unit Faculty of Health Sciences
The University of Sydney
SLIDE 2
Emergency departments – information crossroad
SLIDE 3 CPOE systems – the promise?
retrieval, efficient data management
support mechanisms
(Bernstein et al. 2005 Acad Emerg Med)
quality of care (Aronsky et al
2007 AMIA)
SLIDE 4 The impact of eHealth on Quality and Safety
“ …whilst the number of IT applications in healthcare and software programmes is growing (high dissemination), we still have insufficient understanding of who, why, and under what conditions, such interventions might work (low evaluation)”
Car et al. (2008) A systemic overview and synthesis of the literature. London Imperial College and The University of Edinburgh
SLIDE 5
Theory-based evaluation
A frame of reference that helps us to understand the world, a guideline for analysing phenomena and comprehending their significance
SLIDE 6
Black box versus theory based evaluation
Evaluation studies cannot avoid theory because by their very nature they seek to discover whether something works or not. Even the introduction of a new IT system is based on a theory - that its introduction will make things better.
SLIDE 7 Kaplan’s 4Cs framework
The interaction between technology, people, tasks and
- rganisational structure
- 1. Communication
- 2. Care
- 3. Control
- 4. Context
SLIDE 8 Research setting
- ED with 66-bed capacity in
large Sydney suburban teaching hospital
- 150-180 patients per day
- Cerner Millennium
PowerChart (2004.01)
months after implementation
- Area Health Service approval
SLIDE 9 Research methods
- Doctors - 7 semi structured interviews
and one focus group (nine participants)
- Nurses – 4 focus groups (16 participants)
- Chain referral sampling
- Concurrent data analysis (NVivo)
employing grounded theory techniques
SLIDE 10 Expectations
We’ve worked with computer systems here for years now and they’re not
- foolproof. You’ve got down time, there’s
a lot of things, so I didn’t really have the expectations of it, that it would be the solution to our problems. (ED Registered Nurse)
SLIDE 11 Responsibility shifts
entry tasks and responsibilities
nurse order entry
SLIDE 12
Monitoring the test order process
Whereas before in the old … system, if you sent down a blood test, as soon as it was logged in, as a test being done, it would say “to follow”, until you actually got a result. Whereas now, it says you’ve ordered it, but if you just go to look at the results, it just won’t give you any result until there is a result. It won’t say it is in the system; it’s not ready yet. (ED Staff Specialist)
SLIDE 13
System usability
SLIDE 14
SLIDE 15
System requirements
You know - when you order this test you have to do this. It’s like yes of course I bloody know that, I’ve been ordering this test for 20 years. Like the X-ray box when you click X-ray, it will come up saying you have to order an X-ray for a particular part of the body. Really? Thanks very much, I know that. I mean they’re just useless bits of support. It just irritates people; it added nothing to the process. (ED consultant)
SLIDE 16 Kaplan’s 4Cs framework
Theme Communication Care Control Context Expectations
X
Changes in responsibility
X
Monitoring the test
X X
System usability
X X
System requirements
X X
SLIDE 17 Implications
factors
deployment of decision support
consequences
negotiated process
SLIDE 18
Thank you
www.fhs.usyd.edu.au/hireu a.georgiou@usyd.edu.au
