Efficiency Achievements from a User-Developed Real-Time Modifiable Clinical Information System

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This is a review of Roderick O. Bishop, Jon Patrick, Ali Besiso 2015 article, “Efficiency Achievements from a User-Developed Real-Time Modifiable Clinical Information System”. [1]


To improve efficiency and performance issues of clinical staff in emergency departments (ED) caused by the introduction of new clinical information systems (CIS), the researchers performed an investigation to improve the design and implementation of a CIS using a collaborative approach and a new design philosophy.


Researchers selected the Nepean Hospital Emergency Department to design and develop a system by using a mixture of their new design approaches. They also attempted to identify any sensible reduction in ED personnel difficulties in using the system in comparison to existing commercial system (Cerner). Finally, they designed and evaluated the possible effects of those improvements on patient care outcome in emergency department.


The study involved a comparison between two systems (Cerner and new proposed system) with respect to efficiency in 17 different ED tasks. By measuring 332 task instances for duration and number of mouse clicks, the results showed that the new system is at least 41% more efficient than Cerner FirstNet (95% confidence interval 21.6% to 59.8%). In some cases, researchers redesigned the new proposed system to evaluate and demonstrate the benefits of feedback to improve the existing system. The cost of the effort in redesigning the new system interface showed that the time spent on redesigning the system has shown a return on investment in just a few days by saving clinicians' time. An analysis between Cerner and new system showed an average difference of 127 seconds and 15.2 clicks. A workflow simulation for a typical patient and a normal daily patient load of 165 patients showed the new system saved 23.9 hours of staff time per day compared with the Cerner system.


This study shows that clinical information systems designed by clinical personnel with assistance of a software technology that enables personalization have a great chance of facilitating efficiency for the ED. In this research emergency department staff claimed that a mouse-based user interface has a greater chance of interrupts in compare with the traditional approach of writing on paper. This issue is relatively resolved by the reduction of cognitive load that achieved from reducing the number of steps to complete a task.


This article demonstrates the importance of customization and also personalization in emergency departments and in general in healthcare information systems. This unattended feature of software applications may have a great impact on the over efficiency of each user, as the output of this study proved this impact. The feature of customization is not only helpful in improving the clinical information system workflows, but also improve the each individual user satisfaction in medical settings. However, there is an important aspect that must be considered in the process of implementing customizable clinical information systems and it is the impact of this customization on patient safety. There is a potential chance of error in any system with high level of access to customization for ordinary users. This risk is a factor that needs consideration when designing a customizable system in any healthcare settings.


  1. Roderick O. Bishop, Jon Patrick, Ali Besiso 2015 Efficiency Achievements from a User-Developed Real-Time Modifiable Clinical Information System http://www.annemergmed.com/article/S0196-0644(14)00491-0/fulltext