Margreet B. Michel-Verkerke

Electronic prescription system: do the professionals use it?

User-adoption of new IT-applications is the proof-of-the-pudding when it comes to IT-success in healthcare. As a consequence, many studies are made of the role of the users in the introduction of new IT in both theory and practice. User satisfaction is widely accepted as a criterion for IS success. However, to understand IS success or failure, it is necessary to recognise its social and technical causes. The USE IT model has four determinants that have to be balanced in assessing the diffusion and use of information systems. Resistance is defined as the degree to which the surroundings and locality negatively influences the users of IT and the degree to which IT-users themselves are opposing or postponing the IT change. Relevance is the degree to which the user expects that the IT-system will solve his problems or help to realise his actually relevant goals. Micro-relevance is the degree to which IT-use helps to solve the here-and-now problem of the user in his working process. Requirements are defined as the degree to which the user needs are satisfied with the product quality of the innovation. Resources are defined as the degree to which material and immaterial goods are available to design, operate and maintain the information system. The USE IT model clearly makes the transition in the onion model of the book from change management (USE) to technological innovation (IT). The empirical results of this qualitative study with 56 cases show that time and communication are the most important factors for General Practitioners for the diffusion and use of an Electronic Prescription System (EPS). The social aspects and technical aspects have to be balanced to get to real use of the information system. The (job) relevance of the EPS to the working process of the professional was, in all 56 cases, the most important determinant. The resistance of the professional that is often used as the main reason for plateaued diffusion was shown to be the cumulative effects of the other determinants. For instance a GP with limited resources (like a slow PC) will get annoyed by the waiting time and will resist the new system using a lot of processing time. At first the technical determinants, requirements and resources, seemed to be a prerequisite for the social determinants. Analysis of this presumption showed that a thorough check on resources is necessary and that a user–provider contract on requirements would help bridge the information gap.

USE IT to Create Patient-Relation Management for Multiple Sclerosis Patients

Patients with multiple sclerosis (MS) visit various healthcare providers during the course of their disease. It was suggested that information and communication technology might help to orchestrate their care provision. We have applied the USE IT tool to get insight in the relevant problems, solutions, and constraints of MS care both in the organizational and the information-technological area. There is hardly a chain of healthcare, but rather, a network in which informal communication plays an important role. This informal network worked reasonably effective, but it was inefficient and slow. The MS patient count is small for most care providers. Patients thought that a lack of experience caused their major problems: insufficient and inadequate care. To improve care, we proposed a solution that combines an MS protocol, the introduction of a central coordinator of care and a patient-relation management (PRM) system. This is a simple Web-based application based on an agreement by the caregivers that supports routing, tracking, and tracing for an MS patient and supplies the caregivers with professional guidelines. It is likely that we would have suggested a far more complicated ICT solution if we had only analyzed the MS care process as such without specific consideration of the dimensions in the USE IT tool.