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PubMed1995

Hospital information management: the need for clinical leadership.

On 12 July the Audit Commission published For Your Information, a well researched report about information and its management in acute hospitals in Britain, how and why it is failing, and steps that clinicians, managers, and the NHS should take to correct this. This article discusses why information management matters to clinicians and considers the problems identified by the Audit Commission--most of which will strike chords with doctors--and possible remedies. Finally, it describes possible routes to administer these remedies and the proposal, recently supported by the BMA Council, for a national centre for health informatics with the goals of educating and enthusing clinicians about informatics, empowering them to participate in local and national information management decisions; exploring how information can be used to improve patient care and outcomes; and evaluating clinical information systems and helping to realise their benefits.

Communication↗
PubMedDate not supplied

Implementation of physician order entry: user satisfaction and self-reported usage patterns.

OBJECTIVES: To evaluate user satisfaction, correlates of satisfaction, and self-reported usage patterns regarding physician order entry (POE) in one hospital. DESIGN: Surveys were sent to physician and nurse POE users from medical and surgical services. RESULTS: The users were generally satisfied with POE (mean = 5.07 on a 1 to 7 scale). The physicians were more satisfied than the nurses, and the medical staff were more satisfied than the surgical staff; satisfaction levels were acceptable (more than 3.50) even in the less satisfied groups. Satisfaction was highly correlated with perceptions about POE's effects on productivity, ease of use, and speed. POE features directed at improving the quality of care were less strongly correlated with satisfaction. The physicians valued POE's off-floor accessibility most, and the nurses valued legibility and accuracy of POE orders most. Some features, such as off-floor ordering, were perceived to be highly useful and reported to be frequently used by the physicians; while other features, such as "quick mode'' ordering and personal order sets, received little self-reported use. CONCLUSIONS: Survey of POE users showed that satisfaction with POE was good. Satisfaction was more correlated with perceptions about POE's effect on productivity than with POE's effect on quality of care. Physicians and nurses constitute two very different types of users, underscoring the importance of involving both physicians and nonphysicians in POE development. The results suggest that development efforts should focus on improving system speed, adding on-line help, and emphasizing quality benefits of POE.

Attitude of Health Personnel↗
PubMedDate not supplied

Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system.

OBJECTIVE: Many hospitals are investing in computer-based provider order-entry (POE) systems, and providers' evaluations have proved important for the success of the systems. The authors assessed how physicians and nurses viewed the effects of one modified commercial POE system on time spent patients, resource utilization, errors with orders, and overall quality of care. DESIGN: Survey. MEASUREMENTS: Opinions of 271 POE users on medicine wards of an urban teaching hospital: 96 medical house officers, 49 attending physicians, 19 clinical fellows with heavy inpatient loads, and 107 nurses. RESULTS: Responses were received from 85 percent of the sample. Most physicians and nurses agreed that orders were executed faster under POE. About 30 percent of house officers and attendings or fellows, compared with 56 percent of nurses, reported improvement in overall quality of care with POE. Forty-four percent of house officers and 34 percent of attendings/fellows reported that their time with patients decreased, whereas 56 percent of nurses indicated that their time with patients increased (P < 0.001). Sixty percent of house officers and 41 percent of attendings/fellows indicated that order errors increased, whereas 69 percent of nurses indicated a decrease or no change in errors. Although most nurses reported no change in the frequency of ordering tests and medications with POE, 61 percent of house officers reported an increased frequency. CONCLUSION: Physicians and nurses had markedly different views about effects of a POE system on patient care, highlighting the need to consider both perspectives when assessing the impact of POE. With this POE system, most nurses saw beneficial effects, whereas many physicians saw negative effects.

Attitude to Computers↗
PubMed1975

Relationship between work environment and anamnestic health status. Use of predictors, indicators and indices for the evaluation of medical and environmental factors.

Experience with computerized medical record systems in handling medical data in hospital and health screening environments has led to the development of a new approach to the evaluation of medical data. Predictors and indicators quantify the "information value" of medical data and can, theoretically, do so for all types of data. This paper describes the methodology and presents the results obtained when the technique was applied to the anamnestic data of the medical history and environmental data about the conditions in the work environment. Over 4,000 individuals who underwent multiphasic health screening were used as a data base for this study. From these 4,000 persons 3,164 were used for the calculation of anamnestic predictors and indicators and 1,013 for the environmental predictors and indicators. Anamnestic environmental indices were calculated upon 77 test individuals so as to correlate the association and dependence of the two indices.

Environmental Exposure↗
PubMed1991

Physicians who use the system help hospitals gain advantage.

The chief consumers of patient information--physicians--are often the last to actually use systems that are designed to provide that information quickly. The reasons for this are deeply entrenched, but if physicians are properly incentivized and adequately trained, they can leap this hurdle. Competitive advantage to hospitals is an immediate benefit, as well.

Chicago↗
PubMed1991

A unique approach persuades physicians. Interview by Carolyn Dunbar and Michael L. Laughlin.

By combining a unique 'sales' approach with a system truly designed to meet users' needs, a Denver physician and medical affairs vice president is convincing healthcare providers that computers are not the way of the future, but of today. During an on-site visit with Computers in Healthcare Editor Carolyn Dunbar and Michael L. Laughlin, industry editor, Patrick Roney, M.D., explained how Denver's Swedish Medical Center is plunging into the Computer Age.

Attitude to Computers↗
PubMed1992

Information technologies. Physician-hospital networks.

Patient care efficiencies and quality of care improvements require progressive efforts to integrate the patient information systems and allow for on-demand accessibility to authorized information users. The dilemma facing the designers and managers of these systems is that each step toward improving accessibility seems to introduce another potential information leakage point. We are reminded once again that information is a very difficult resource to control because it is possible to steal it without removing it physically from its storage place. The essence of information security in physician links is captured by establishing mechanisms for identifying system users, limiting user authority, assuring the privacy of transmitted data, and monitoring system use and users.

Computer Communication Networks↗
PubMed1992

Preparing physicians for a computer-based patient record system.

The Providence experience provides a model which encompasses both preparation for a computer-based patient record and a physician-oriented approach to achieving quality documentation for the physician component of the patient record. The study comparing Providence to a similar medical center demonstrated the value of the new system in achieving quality patient records. Many hospitals in the Seattle area, including Overlake, now use this system or variations of it.

Attitude of Health Personnel↗