Determinants of success of inpatient clinical information systems: a literature review

A Multimethod Approach to Evaluating Critical Care Information Systems

There is increasing awareness of the importance of evaluating and measuring the impacts of a critical care information system (CCIS). Recent evaluation studies provide little information useful to a healthcare team in evaluating a CCIS in practice. A CCIS is expected to have many direct benefits, such as increased user job satisfaction and increased documentation efficiency, accuracy, and quality. This paper reviews a rigorous longitudinal evaluation methodology being employed by a freestanding tertiary care pediatric hospital as they implement a CCIS. The metrics are being used to document the impact, strengths, and limitations of the CCIS they are installing. The main phase of the implementation is currently under way, and results will be released when the evaluation is complete. This article serves to provide an overview of the evaluation methodology for others to consider as they embark on similar endeavors.

Clinical information systems: CareSuite from Picis

In this article, we discuss the implementation of the CareSuite system (Picis, Wakefield, MA) in 5 intensive care units of the Erasmus Medical Center, Rotterdam, the Netherlands. We give a description of the implementation process, and the system as it is currently being used. We also confront the lessons learned during the implementation of this clinical information systems with insights from the research field of implementation, and thereby show the value of a socio-technical approach to clinical information systems implementation.

Take note(s): differential EHR satisfaction with two implementations under one roof

OBJECTIVE

The aim of this study was to rigorously evaluate perceived differences in satisfaction with an electronic health record (EHR) between residents of two medical specialties who share the same health record, practice location, administration, and information technology support.

DESIGN

A cross-sectional survey was used comparing user satisfaction between pediatrics residents and internal medicine residents in an academic practice.

MEASUREMENTS

The survey was designed to measure baseline demographic characteristics, attitudes toward computers, general satisfaction with an EHR, and perceived practicality of use, variation from familiar practice, organizational support, and impact on delivery of care.

RESULTS

Medicine subjects were similar to pediatrics subjects in baseline demographic characteristics. Satisfaction with the EHR implementation was very high for both sets of subjects, but internal medicine residents were significantly less likely to be satisfied with the EHR implementation (relative risk [RR]=0.84, 95% confidence interval [CI]=0.73-0.98) and considerably less likely to believe that their colleagues were satisfied with it (RR=0.56, 95% CI=0.41-0.77). The only surveyed characteristic independently predicting satisfaction was medical specialty (p=0.04). Medicine subjects were less likely to believe template-based documentation improved their efficiency (RR=0.64, 95% CI=0.46-0.88). They were significantly more likely to believe the system had been designed to improve billing (RR=1.50, 95% CI=1.05-2.04) and not to improve patient care (RR=0.61, 95% CI=0.44-0.85).

CONCLUSION

The authors found a difference in satisfaction between internal medicine and pediatrics users of an EHR. Although many potential factors that influence satisfaction were similar between subjects in the two specialties, differences in previous experience may have influenced the results. Medicine residents had more previous experience with a different EHR implementation, which they may have perceived as superior to the one involved in this study. Pediatric residents had more previous experience with structured data entry prior to EHR implementation and more preventive care patient encounters for which structured data entry may be well suited. Since successful implementations generally require satisfied users, understanding what factors affect satisfaction can improve chances of a system's success.