Rebecka Janols

Three Key Concerns for a Successful EPR Deployment and Usage

The health care environment is unique because of the large and complex organisation with a traditional hierarchic structure that is governed by laws and regulations. This paper examines how a large Swedish health care organisation work with usability issues regarding Electronic Patient Record (EPR) deployment and usage. EPR systems have great impact on work environment and clinical work routines will not be performed in the same way as before. This paper analyse how the EPR management and core business understand their EPR responsibilities and work with usability aspects at different levels in the organisations. The paper reveals that there is a conflict about responsibility between EPR management and core business management. The reasons for the confusion are contradictive understanding of what an EPR system is, an IT system or a tool for the core business to perform better health care work. This leads to that care staffs experience regarding the EPR systems usability, is not being listened to within the organisation. Three key concerns for a successful EPR deployment and usage are identified and further analysed; education, evaluation and support & improvement ideas.

Physicians' concept of time usage : A key concern in EPR deployment

This paper is based on an interview study with 19 resident, specialist and senior physicians. The study was initiated by a Swedish Hospital management to investigate physicians’ attitude towards their EPR (Electronic Patient Records) and give recommendations for improvement in organization, development, deployment and training. The management had experienced that the physicians were unwilling to take part in the EPR deployment process and simultaneously complained about the low usability and potential safety risks of the systems. The study shows that the EPR must be considered a shared responsibility within the whole organization and not just a property of the IT department. The physicians must consider, and really experience, EPR as efficient support in their daily work rather than something they are forced to use. This includes considering work with the EPR as an important part of their work with patients.

Same system---different experiences: physicians' and nurses' experiences in using IT systems

In this paper we use a sociotechnical approach and theories about group processes to analyse how two main clinician groups, nurses and physicians, are influenced by their main IT tool, the Electronic Patient Record (EPR), in their clinical practice. The paper is based on interviews with 19 physicians and 17 nurses that work at a Swedish university hospital. The clinicians considered the use of an EPR system necessary, but experienced the need to change their clinical practice to less efficient work routines in order for the EPR system to support them. The main result of the paper is that the EPR system affected nurses and physicians differently. The physicians were more frustrated and experienced that the EPR system worsened their clinical practice and a decreased status among the other clinical professions. The nurses on the other hand experienced that their work became more visible than before and found it easier to claim the importance of their work towards the physicians.

On the establishment of user-centred perspectives

This paper examines the obstacles for and discusses possible solutions to successfully establishing a User Centred Perspective (UCP) in organisations. The analysis is made with the use of the theory Communities of Practice (CoP). The analysis is based on a cross case study based on two longitudinal action research projects. In these studies we identified four CoP considered important; users, core business managers, IT coordinators and system developers. The analysis shows in what ways the communities contribute to the difficulties for a successful establishment of UCP. One example is marginalising the IT coordinator community, and another is imperialism of the system developer community as well as the lack of boundary spanning skills. The results indicate that we need to influence all levels in organisations, with a focus on boundaries between communities, in order to successfully introduce a UCP. Boundary spanning objects need to be identified and knowledge sharing needs to be enhanced.

Time does not heal usability issues!: results from a longitudinal evaluation of a health it deployment performed at three Swedish hospital units

This paper presents a longitudinal evaluation of user adoption during a Patient Administrative System (PAS) deployment. The research was performed at three units within a Swedish university hospital. Both qualitative and quantitative methods have been used to gather data before, during and up to two years after the deployment. The results show that all users experienced usability problems. After two years of usage the system was still not considered to be as supportive as the old system. The users that were required to use the system felt unsure and stressed about whether all information was consulted or not. The users that were less dependent on the system solved the problems by not doing the tasks; instead they let the clerks continue to do the PAS tasks as they did before the deployment. The results indicate that time will not heal usability problems; instead they need to be addressed in other ways.