Beyond the EPR: Complementary roles of the hospital-wide electronic health record and clinical departmental systems

BackgroundMany hospital departments have implemented small clinical departmental systems (CDSs) to collect and use patient data for documentation as well as for other department-specific purposes. As hospitals are implementing institution-wide electronic patient records (EPRs), the EPR is thought to be integrated with, and gradually substitute the smaller systems. Many EPR systems however fail to support important clinical workflows. Also, successful integration of systems has proven hard to achieve. As a result, CDSs are still in widespread use. This study was conducted to see which tasks are supported by CDSs and to compare this to the support offered by the EPR.MethodsSemi-structured interviews with users of 16 clinicians using 15 different clinical departmental systems (CDS) at a Medium-sized University hospital in Norway. Inductive analysis of transcriptions from the audio taped interviews.ResultsThe roles of CDSs were complementary to those of the hospital-wide EPR system. The use of structured patient data was a characteristic feature. This facilitated quality development and supervision, tasks that were poorly supported by the EPR system. The structuring of the data also improved filtering of information to better support clinical decision-making. Because of the high value of the structured patient data, the users put much effort in maintaining their integrity and representativeness. Employees from the departments were also engaged in the funding, development, implementation and maintenance of the systems.ConclusionClinical departmental systems are vital to the activities of a clinical hospital department. The development, implementation and clinical use of such systems can be seen as bottom-up, user-driven innovations.

[1]  M. Musen,et al.  Handbook of Medical Informatics , 2002 .

[2]  Aksel Tjora,et al.  Maintaining redundancy in the coordination of medical emergencies , 2004, CSCW.

[3]  Graham Scambler,et al.  Square pegs in round holes: information systems, hospitals and the significance of contextual awareness. , 2009, Social science & medicine.

[4]  Jane Grimson,et al.  Federated healthcare record server - the Synapses paradigm , 1998, Int. J. Medical Informatics.

[5]  Joachim Dudeck,et al.  XML-based application interface services - a method to enhance integrability of disease specific systems , 2002, Int. J. Medical Informatics.

[6]  Jeremy C. Wyatt,et al.  Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs , 2007, BMC Medical Informatics Decis. Mak..

[7]  William M. Riggs,et al.  Incentives to innovate and the sources of innovation: the case of scientific instruments☆ , 1994 .

[8]  H. Lærum,et al.  Doctors' use of electronic medical records systems in hospitals: cross sectional survey , 2001, BMJ : British Medical Journal.

[9]  A. Strauss,et al.  The Discovery of Grounded Theory , 1967 .

[10]  E. von Hippel,et al.  Sources of Innovation , 2016 .

[11]  Carla Simone,et al.  When once is not enough: the role of redundancy in a hospital ward setting , 2005, GROUP.

[12]  Eric A. von Hippel,et al.  How Open Source Software Works: 'Free' User-to-User Assistance? , 2000 .

[13]  Ayfer Ali,et al.  The Major Role of Clinicians in the Discovery of Off‐Label Drug Therapies , 2006, Pharmacotherapy.

[14]  Eivind Vedvik,et al.  The fate of clinical department systems at the dawn of hospital-wide Electronic health records in a Norwegian university hospital , 2006, MIE.

[15]  Klaus A. Kuhn,et al.  Hospital Information Systems: Chances and Obstacles on the Way to Integration , 1999, MIE.

[16]  John Cullen,et al.  Democratizing Innovation , 2020, Encyclopedia of Creativity, Invention, Innovation and Entrepreneurship.

[17]  Gunnar Ellingsen,et al.  A Patchwork Planet Integration and Cooperation in Hospitals , 2003, Computer Supported Cooperative Work (CSCW).

[18]  J. Corrigan,et al.  COMMITTEE ON DATA STANDARDS FOR PATIENT SAFETY , 2004 .

[19]  Aksel Tjora,et al.  No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record , 2008, BMC Medical Informatics Decis. Mak..

[20]  E Monteiro,et al.  Integrating Health Information Systems: A Critical Appraisal , 2003, Methods of Information in Medicine.

[21]  S. Kvale,et al.  InterViews: Learning the Craft of Qualitative Research Interviewing , 1996 .

[22]  Patrice Degoulet,et al.  Integration of medical applications: the 'mediator service' of the SynEx platform , 2000, Int. J. Medical Informatics.

[23]  E. Nelson,et al.  Building Measurement and Data Collection into Medical Practice , 1998, Annals of Internal Medicine.