Discovering How to Think about a Hospital Patient Information System by Struggling to Evaluate It: A Committee’s Journal

Article summary:

The article reviews experience by one patient care information systems committee on learning to think about the purpose of a patient information management system and evaluating the impact of its implementation.

A committee was formed at a large academic hospital to 1) improve inpatient clinical IT systems by determining desirable features for their electronic patient information management system, 2) minimize work disruption during system implementation, and 3) evaluate the consequences of replacing the previous technology. The group initially thought this would be a straight forward task, but it became clear quickly that this was a much more complex job than they had previously thought.

The first lesson that the group learned was that identifying what they measure must come after developing a clear, explicitly articulated idea of what they are trying to achieve. Data gathering is only the beginning; to transform data into knowledge, there must be a clear understanding of the goal and meaning of the system before they can use the data to design and evaluate it. The group therefore developed a framework to carefully assess the meaning and quality of the collected data.

Another important observation that the group had arrived at was that clinical workflow and tools are closed related. When thinking about future systems/tools, a new workflow must accompany it. Workers are usually accustomed to a particular way of working and may have problem imagining new ways that are made possible by new tools that enable things they never dreamed of. When facilitating data gathering sessions, it is important to promote creativity and should expect controversies and delayed acceptance as workers break free of the status quo and vision their future processes.

Lastly, the group realized that it was impossible to anticipate every issue that will arise after implementation, while they should try their best to consider all potential risks, realistic expectation must be set to understand they may not recognize what they were looking at until after it occurred.

Comments:

Most hospitals that went through the planning and evaluation of clinical information system can resonate with the observations and experience in this paper. Designing and gathering data about future clinical information system is incredibly complex and can be overwhelming for everyone.

Data gathering is a critical step in evaluating the system, but it is not enough to just know what data to gather, you also need to be able to distinguish the usefulness of the data by understanding how data was formulated and used.

The paper brings up an excellent observation on the relationship between tools and workflow. It is useless to ask workers to define problems and provide solutions based on their current workflow and knowledge because all these may change when future technologies and new tools become available. Proper education and training along with creativity and well-defined visions must be encouraged during the planning and design sessions. This is no easy task, but is essential to the design and evaluation of a clinical information system.

Researching other institutes that have been through the process and their evaluation framework can be very helpful. However, information gathered must be put into context; evaluation framework and data gathered for an academic teaching hospital may be different from a community non-teaching hospital. Finding experience by an institution similar to the one you are in would be the best approach.

Lastly, the best advice for any hospital evaluating their clinical information system is to expect long, frustrating, controversy debates and understand that these are part of the normal process. Also, no matter how well researched or well prepared you think you may be, there will always be challenges and unexpected lessons throughout the process. Learn to expect the unexpected is probably the best suggestion for institutions planning and evaluating a clinical information system.