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

OBJECTIVE To determine the percentage of time that intensive care unit (ICU) nurses spend on documentation and other nursing activities before and after installation of a third-generation ICU information system. Design Prospective data collection using real-time time-motion analysis, before and after installation of the ICU information system. Setting A ten-bed surgical ICU at a Veterans Affairs medical center. Subjects ICU nurses. Interventions Installation of a third-generation ICU information system. Measurements and main results Ten ICU nurses were studied before and after installation of the ICU information system. Each ICU nurse's activities and tasks, during 4-hr observation periods, were categorized in real-time by a nurse observer and recorded in a laptop computer. Each recorded task was automatically time-stamped and logged into a data file. The percentage of time spent on documentation decreased from 35.1 +/- 8.3% to 24.2 +/- 7.6% (p =.025) after the ICU information system was installed. The percentage of time providing direct patient care increased from 31.3 +/- 9.2% to 40.1 +/- 11.7% (p =.085). The percentage of time doing patient assessment, a direct patient care task, increased from 4.0 +/- 4.7% to 9.4 +/- 4.4% (p =.001). Conclusions Installation of a third-generation ICU information system decreased the percentage of time ICU nurses spent on documentation by >30%. Almost half of the time saved on documentation was spent on patient assessment, a direct patient care task.

Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system.

Objective : To measure the impact on nursing activity of introducing computerized medical records into intensive care units (ICUs). Design : Prospective data collection monitoring the activity of ICU nurses before and after installation of a computerized charting system. Setting : A six-bed coronary care unit and an eight-bed medical ICU at the Minneapolis VA Medical Center. Subjects : Registered nurses providing intensive care services. Interventions : Installation of a Clinical Information System that computerized the ICU medical records. Measurements and Main Results : Before computer installation, nurses spent 24% of their time manipulating data (7% gathering and 17% charting). After installation, charting time decreased to 10%, and data gathering time decreased to 4%, while 10% of time was spent at computer terminals entering or reviewing data. The total time manipulating data postinstallation was thus 24% (i.e., unchanged from previous). Computerized charting did not alter time spent in patients' rooms (43% pre- and 43% postinstallation) compared with time spent at the central station (37% pre- and 36% postinstallation) or elsewhere (20% pre- and 21% postinstallation). Relative time spent at various tasks varied between units and from shift to shift, but the net effect of computerized charting was that nurses had more time available at the central station for monitoring, and that the computer terminals were used primarily in the patient rooms. Conclusions : Computerized charting will not necessarily provide ICU nurses with a net excess of time for tasks unrelated to manipulating data. (Crit Care Med 1995 ; 23 :1067-1073)

Effect of computerized charting on nursing activity in intensive care.

A qualitative comparison of paper flowsheets vs a computer-based clinical information system.

The integration of computers into critical care is by no means a new concept. Clinical information systems have evolved in the critical care setting over the past three decades. Their use by critical care healthcare providers has increased exponentially in the past few years. More recently, with the advent of the electronic medical record, clinicians in the ICU may obtain and share useful information both bedside and remotely. Clinical information systems and the electronic medical record in the ICU have the potential to improve medical record movement problems, to improve quality and coherence of the patient care process, to automate guidelines and care pathways, and to assist in clinical care and research, outcome management, and process improvement. In this article, we provide some historical background on the clinical information system and the electronic medical record and describe their current utilization in the ICU and their role in the practice of critical care medicine in decades to come.

H. M. Johnson

Papers

Clinical evaluation of a computer-based patient monitoring and data management system.

Data Entry Analysis of a Computerized Clinical Information System