Evaluating computerized health information systems: hardware, software and human ware: experiences from the Northern Province, South Africa

Health Professionals' readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study

Background

Electronic medical record systems are being implemented in many countries to support healthcare services. However, its adoption rate remains low, especially in developing countries due to technological, financial, and organizational factors. There is lack of solid evidence and empirical research regarding the pre implementation readiness of healthcare providers. The aim of this study is to assess health professionals’ readiness and to identify factors that affect the acceptance and use of electronic medical recording system in the pre implementation phase at hospitals of North Gondar Zone, Ethiopia.

Methods

An institution based cross-sectional quantitative study was conducted on 606 study participants from January to July 2013 at 3 hospitals in northwest Ethiopia. A pretested self-administered questionnaire was used to collect the required data. The data were entered using the Epi-Info version 3.5.1 software and analyzed using SPSS version 16 software. Descriptive statistics, bi-variate, and multi-variate logistic regression analyses were used to describe the study objectives and assess the determinants of health professionals’ readiness for the system. Odds ratio at 95% CI was used to describe the association between the study and the outcome variables.

Results

Out of 606 study participants only 328 (54.1%) were found ready to use the electronic medical recording system according to our criteria assessment. The majority of the study participants, 432 (71.3%) and 331(54.6%) had good knowledge and attitude for EMR system, respectively. Gender (AOR = 1.87, 95% CI: [1.26, 2.78]), attitude (AOR = 1.56, 95% CI: [1.03, 2.49]), knowledge (AOR = 2.12, 95% CI: [1.32, 3.56]), and computer literacy (AOR =1.64, 95% CI: [0.99, 2.68]) were significantly associated with the readiness for EMR system.

Conclusions

In this study, the overall health professionals’ readiness for electronic medical record system and utilization was 54.1% and 46.5%, respectively. Gender, knowledge, attitude, and computer related skills were the determinants of the presence of a relatively low readiness and utilization of the system. Increasing awareness, knowledge, and skills of healthcare professionals on EMR system before system implementation is necessary to increase its adoption.

Can electronic tools help improve nursing home quality?

Background. Nursing homes face challenges in the coming years due to the increased number of elderly. Quality will be under pressure, expectations of the services will rise, and clinical complexity will grow. New strategies are needed to meet this situation. Modern clinical information systems with decision support may be part of that. Objectives. To study the impact of introducing an electronic patient record system with decision support on the use of warfarin, neuroleptics and weighing of patients, in nursing homes. Methods. A prevalence study was performed in seven nursing homes with 513 subjects. A before-after study with internal controls was performed. Results. The prevalence of atrial fibrillation in the seven nursing homes was 18.8%. After intervention, the proportion of all patients taking warfarin increased from 3.0% to 9.8% (P = 0.0086), neuroleptics decreased from 33.0% to 21.5% (P = 0.0121), and the proportion not weighed decreased from 72.6% to 16.0% (P < 0.0001). The internal controls did not change significantly. Conclusion. Statistics and management data can be continuously produced to monitor the quality of work processes. The electronic health record system and its system for decision support can improve drug therapy and monitoring of treatment policy.

Factors influencing the use of IT in the emergency department: a qualitative study

Investigating factors influencing the use of clinical information systems can help to develop a strategy to improve user acceptance of a given system or similar ones in the future. In this research, we investigated factors influencing the use of information technology in the emergency department (ED). We undertook a qualitative study in which data were collected using semi-structured interviews with the ED staff. In total, 34 interviews were conducted and data were analysed using framework analysis. The results showed that user characteristics and perception of task, technology, environment, and impact of technology could influence people's use of IT in the ED. Of these, the usefulness of the systems, the impact of technology, IT training, and the feasibility of using IT by all members of staff seemed to be the main concerns. Addressing these factors in designing and implementing a system could help to introduce the change successfully and improve the acceptance of information technology.

Challenges to implementing the national programme for information technology (NPfIT): a qualitative study

OBJECTIVES

To describe the context for implementing the national programme for information technology (NPfIT) in England, actual and perceived barriers, and opportunities to facilitate implementation.

DESIGN

Case studies and in depth interviews, with themes identified using a framework developed from grounded theory.

SETTING

Four acute NHS trusts in England.

PARTICIPANTS

Senior trust managers and clinicians, including chief executives, directors of information technology, medical directors, and directors of nursing.

RESULTS

The trusts varied in their circumstances, which may affect their ability to implement the NPfIT. The process of implementation has been suboptimal, leading to reports of low morale by the NHS staff responsible for implementation. The overall timetable is unrealistic, and trusts are uncertain about their implementation schedules. Short term benefits alone are unlikely to persuade NHS staff to adopt the national programme enthusiastically, and some may experience a loss of electronic functionality in the short term.

CONCLUSIONS

The sociocultural challenges to implementing the NPfIT are as daunting as the technical and logistical ones. Senior NHS staff feel these have been neglected. We recommend that national programme managers prioritise strategies to improve communication with, and to gain the cooperation of, front line staff.

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

Factors affecting the use of nursing information systems in Taiwan

AIM

This paper reports a study to test a proposed model of factors (demographic variables, computer experience and perceived technology characteristics) influencing the efficient use of a computerized nursing care planning system by hospital clinical nurses.

BACKGROUND

Although nursing information systems have been used in health care institutions, little research has explored the efficiency of computer use in nurses' daily practice.

METHOD

A secondary data analysis was applied to focus on clinical nurses' daily computer use. The original data were collected from a medical centre in Taiwan to establish the reliability and validity of a scale to evaluate computerized nursing care plan systems.

RESULTS

Younger nurses with more education, less computer knowledge and less usage pressure, and who perceived that they had less usage benefit, more education training and usability regarding system use, spent less time on the computerized nursing care plan.

CONCLUSION

The results can be used for further organization of education programmes and as a reference for training strategies. Further examination and analysis of item content are suggested.

Nurses’ concerns about using information systems: analysis of comments on a computerized nursing care plan system in Taiwan

AIMS AND OBJECTIVES

The purpose of this study was to pursue a deeper understanding of nurses' perceptions of a computerized nursing care plan as written in comments on a survey.

BACKGROUND

Studies have examined nurses' perceptions of computer use, but comments written on surveys of computerized nursing care planning have never been reported and the pattern and meaning of such feedback have not been systematically analysed.

DESIGN

Of 738 nurses in Taiwan who completed a two-part survey to evaluate a computerized nursing care plan, 202 responded on part II to an open-ended question about overall perceptions of a nursing information system.

METHODS

A sample of 10 questionnaires with comments was subjected to qualitative content analysis. Key words and phrases were identified, then grouped into categories, which were used to code the remaining respondents' comments. Another 20 were used to pilot test these coding categories. The final coding categories were applied to all 202 questionnaires with comments for data analysis.

RESULTS

Nurses were concerned about inconvenient access to computers; reduced work efficiency; inability to individualize patient care and nursing specialty deficiencies; poor content design, system function, and system integration; using the system as a policy requirement; and privacy and legal issues.

CONCLUSIONS

Hardware availability, content design and user training/education programmes are critical issues that affect nurses' use of computers in their daily practice.

RELEVANCE TO CLINICAL PRACTICE

These comments can be applied in strategic planning and staff development programmes to further use of information systems in patient care.

Evaluation of computerized nursing care plan: Instrument development

With the increasingly popular use of information technology in patient care, the need for reliable instrumentation to evaluate information systems has become critical. This article describes the psychometric testing of a scale developed to evaluate a computerized nursing care plan (CNCP) system. A review of the literature generated a 44-item questionnaire, which was then administered to a convenience sample of 729 hospital nurses in Taiwan. Factor analysis (principal component analysis with varimax rotation) and item analysis were applied to establish the scale's construct validity and reliability. Twenty-two items selected from the original 44-item pool were grouped into 6 major constructs: patient care, nursing efficiency, professionalism, usage benefit, education and training, and usability. The alpha coefficient was 0.85. The statistical results showed that nurses generally valued using the CNCP system. Further psychometric analysis of the scale is suggested in other nursing populations, for subscale development and to refine item wording.

Evaluation of health information systems-problems and challenges

OBJECTIVES

Information technology (IT) is emerging in health care. A rigorous evaluation of this technology is recommended and of high importance for decision makers and users. However, many authors report problems during the evaluation of information technology in health care. In this paper, we discuss some of these problems, and propose possible solutions for these problems.

METHODS

Based on own experience and backed up by a literature review, some important problems during IT evaluation in health care together with their reasons, consequences and possible solutions are presented and structured.

RESULTS AND CONCLUSIONS

We define three main problem areas-the complexity of the evaluation object, the complexity of an evaluation project, and the motivation for evaluation. Many evaluation problems can be subsumed under those three problem areas. A broadly accepted framework for evaluation of IT in healthcare seems desirable to address those problems. Such a framework should help to formulate relevant questions, to find adequate methods and tools, and to apply them in a sensible way.

North and South: bridging the information gap

Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how technical fixes--such as the internet--might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty.