Inger Dybdahl Sørby

Characterising cooperation in the ward: framework for producing requirements to mobile electronic healthcare records

We present a framework for characterising hospital scenarios involving the patient chart. The paper-based chart is regarded as simple, efficient, and handy for mobile use by patient-care teams. However, the chart is available in only one physical place at a time, and it needs to be manually synchronised with the electronic healthcare record (EHR). The framework presented in this paper has been developed for use in non-participatory, observational studies performed at the University Hospital of Trondheim, conducted as a part of the MOBEL (MOBile ELectronic patient chart) project at NTNU. We have developed the framework iteratively; repeatedly observing groups in the ward, characterising observations in the framework, and changing attributes and outcome values. This paper presents our latest framework, a representative choice of scenarios, and their characterisation. We conclude with a discussion of results so far, the method, and the utility in the development of the MEPC.

Towards a tomographic framework for structured observation of communicative behaviour in hospital wards

The research presented in this paper investigates how observation of information- and communication-intensive work in hospital wards can be used to produce requirements for mobile clinical information systems. Over a number of years, we have explored how important properties of clinical situations can be captured through structured observations of actors, processes, and systems. In the paper, we present experience from four observational studies of a total of more than 400 hours in hospital wards. Based on the observational studies, we propose a framework for structured, tomographic, observation of clinical work practice. We also briefly discuss and illustrate how the field data can be analyzed and used as input to the requirements engineering process.

Does the Electronic Patient Record Support the Discharge Process? A Study on Physicians' Use of Clinical Information Systems during Discharge of Patients with Coronary Heart Disease

This study has been performed in order to categorise and measure usage of different information sources and types in a well defined stage of clinical work. The underlying motivation is to improve computer-supported presentation and retrieval of relevant information and to be able to evaluate the functionality of a future improved interface to the electronic patient record (EPR). By observing 52 discharge processes and categorising information types and sources, we have observed that the paper chart is used as a primary source of information about recent events and procedures, while the EPR is mostly used for retrieving background information and verification. Direct communication with other clinicians and the patient is also important during the discharge process. Results from an additional survey show that the physicians report greater use of the EPR than the result from the observational study. The study clearly indicates that there is a large potential for improved EPR systems that support the physicians in their work regarding discharge of patients, especially in the future planning part of the discharge.

Query-based requirements engineering for health care information systems: Examples and prospects

Designing healthcare information systems is a challenge to software engineering theory and practice. Many requirements engineering (RE) methods demand user-participation, clear functional objectives and a well defined context of use. These demands are hard to meet in the healthcare domain, which is characterized by high diversity, complexity and little time and money to spend. There are many examples of healthcare software systems that have failed due to lacking investment in the early phases of design and requirements analysis. We have developed methods for gathering detailed observational data about care and communication practice. In this article, we explain how this data can be used for iterative, demand-driven, requirements elicitation and to answer design questions. The examples are taken from structured observation of actors, situations, information usage and activities at two Norwegian hospitals. We regard this approach as a useful supplement to other RE methods, in particular for agile development methods.

Session-Aware Clinical Information Systems

Modern health information systems must be able to represent and reason about work-processes, roles, tasks and interaction in order to provide relevant and timely support. However, commonly used models of work and interaction does not address the details of everyday clinical collaborative communication. If we are to design clinical information systems that support processes, we have to deal with the reality as perceived by the clinician: A puzzle of information and communication about patients, decisions and events. We have identified that it is important to support and represent the dialogue between one or more users and systems.