Showing papers by "Vivian Vimarlund published in 2009"

Understanding business intelligence in the context of healthcare

Abstract: In todays fast changing healthcare sector, decision makers are facing a growing demand for both clinical and administrative information in order to comply with legal and customer-specific requirements. The use of business intelligence (BI) is seen as a possible solution to this actual challenge. As the existing research about BI is primarily focused on the industrial sector, it is the aim of this contribution to translate and adapt the current findings for the healthcare context. For this purpose, different definitions of BI are examined and condensed in a framework. Furthermore, the sector-specific preconditions for the effective use and future role of BI are discussed.

Health Information System Implementation: A Qualitative Meta-analysis

Abstract: Healthcare information systems (HISs) are often implemented to enhance the quality of care and the degree to which it is patient-centered, as well as to improve the efficiency and safety of services. However, the outcomes of HIS implementations have not met expectations. We set out to organize the knowledge gained in qualitative studies performed in association with HIS implementations and to use this knowledge to outline an updated structure for implementation planning. A multi-disciplinary team performed the analyses in order to cover as many aspects of the primary studies as possible. We found that merely implementing an HIS will not automatically increase organizational efficiency. Strategic, tactical, and operational actions have to be taken into consideration, including management involvement, integration in healthcare workflow, establishing compatibility between software and hardware and, most importantly, user involvement, education and training. The results should be interpreted as a high-order scheme, and not a predictive theory.

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

Abstract: Background: Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods: The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. Results: More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P < 0.001). Similarly, more physicians (73.9%) than nurses (50.7%) reported that they found the system not adapted to their specific professional practice (P = < 0.001). Also more physicians (25.0%) than nurses (13.4%) stated that they did want to return to the previous system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P < 0.001) higher among nurses (39.6%) than physicians (16.5%). However, physicians' agreements with the compatibility of the CPOE and with its complexity were significantly higher than the nurses (P < 0.001). Conclusions: Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while not forgetting that it also is necessary to inform the users about the potential benefits involved.

Integrated electronic prescribing systems: pharmacists' perceptions of impact on work performance and patient safety

Abstract: Integrated electronic prescribing systems (IEPSs) are expected to improve efficiency and safety in the management of pharmaceuticals throughout the healthcare sector. We examined the introduction of an IEPS into pharmacists' work performance with regard to impact on efficiency and patient safety. A questionnaire was distributed to all pharmacists (n = 85) in a Swedish municipality (pop. 145,000) where an IEPS had recently been introduced. The response rate was 74%. We found that, in general, the IEPS was perceived to have expedited the processing of prescriptions and reduced the risk for prescription errors, as well as the handing over of erroneous medications to patients. Pharmacists were more cautious about the residual risks for making mistakes than the pharmacist's assistants. We conclude that the introduction of an IEPS was well received by local-level pharmacy staff, but that an IEPS does not automatically reduce the need for qualified personnel in the management of pharmaceuticals.

Introduction of an Integrated ElectronicPrescribing System : The Pharmacies StaffDimension

Abstract: Health Information Systems (HISs) are implemented to support individuals,organizations, and society, making work processes integrated andcontributing to increase service quality and patient safety. However, theoutcomes of many HIS implementations in both primary care and hospitalsettings have either not met yet all the expectations decision-makersidentified or have failed in their implementation. There is, therefore, agrowing interest in increasing knowledge about prerequisites to be fulfilledin order to make the implementation and adoption of HIS more effective andto improve collaboration between healthcare providers. The general purpose of the work presented in this thesis is to explore issuesrelated to the implementation, use, and adoption of HISs and its contributionfor improving inter- and intra-organizational collaboration in a healthcarecontext. The studies included have, however, different research objectivesand consequently used different research methods such as case study,literature review, meta-analysis, and surveys. The selection of the researchmethodology has thus depended on the aim of the studies and their expectedresults. In the first study performed we showed that there is no standard frameworkto evaluate effects and outputs of implementation and use of ICT-basedapplications in the healthcare setting, which makes the comparison ofinternational results not possible yet. Critical issues, such as techniques employed to teach the staff when usingintegrated system, involvement of the users in the implementation process,and the efficiency of the human computer interface were particularlyreported in the second study included in this thesis. The results of this studyalso indicated that the development of evidence-based implementation processes should be considered in order to diminish unexpected outputs thataffect users, patients and stakeholders. We learned in the third study, that merely implementing of a HIS will notautomatically increase organizational efficiency. Strategic, tactical, andoperational actions have to be taken into consideration, includingmanagement involvement, integration in healthcare workflow, establishingcompatibility between software and hardware, user involvement, andeducation and training. When using an Integrated Electronic Prescribing System (IEPS), pharmaciesstaff declared expedited the processing of prescriptions, increased patientsafety, and reduced the risk for prescription errors, as well as the handingover of erroneous medications to patients. However, they stated also that thesystem does not avoid all mistakes or errors and medication errors stilloccur. We documented, however, in general, positive opinions about theIEPS system in the fifth article. The results in this article indicated thatsafety of the system compared to a paper-based one has increased. Theresults showed also an impact on customer relations with the pharmacy; andprevention of errors. However, besides finding an adoption of the IEPS, weidentified a series of undesired and non planned outputs that affect theefficiency and efficacy of use of the system. Finally, we captured in the sixth study indications for non-optimality in thecomputer provider entry system. This is because; the system was not adaptedto the three-quarters of physicians and one-half of nurses’ specificprofessional practice. Respondents pointed out also human-computerinteraction constrains when using the system. They indicated also the factthat the system could lead to adverse drug events in some circumstances. The work presented in this thesis contributes to increase knowledge in thearea of health informatics on how ICT supports inter- and intraorganizationalcollaborative work in a healthcare context and to identifyfactors and prerequisites needed to be taken into consideration whenimplementing new generations of HIS.