Information access at the point of care: what can we learn for designing a mobile CPR system?
Introduction
Health care professionals use the patient record as their principal repository of information. It contains clinical data—like diagnoses, vital signs, diagnostic, or operating reports—and supports the professionals with needed information for frequent decision-making [1] as well as their cooperation with colleagues [2]. With the advent of computer technology in health care, hospitals have started to migrate from paper-based to computerized patient records (CPR). Introduction of CPR reduces archiving costs [3], but more importantly it improves the availability and the quality of information available to health care professionals [4], [5], [6], which is a crucial factor in health care, as lack of information can lead to errors [7].
The majority of today’s CPR systems at hospitals are stationary. To access CPR information, physicians use a clinical workstation that is usually located at the physician’s office. But in their daily routine health care professionals are highly mobile. They move frequently between their office, the ward and treatment rooms. This suggests that the use of mobile computers would support the professionals’ information processing at the point of care.
Development and use of mobile computers in health care is still rare [8], [9], [10]. Studies evaluating prototypes have revealed that acceptance of such tools was rather low [9], [11], although physicians principally would like to use a mobile CPR system. Lack of acceptance might be due to the fact that the users needs have not been analyzed carefully to ensure proper usability of the system [12], [13], [14]. Empirical detailed on-site evaluation of the work practices and context in which the tool will be used is essential to accurately assess the user needs [15].
Our research focused on CPR use in the context of the daily round. This working process plays a vital role in patient management at the hospital, as this is the time when patient, physician, and nurses meet simultaneously. The physician’s daily decision-making and information-gathering for in-patients is processed to a great extent during the round.
To investigate the physicians’ needs in this working context, we addressed the following questions:
- (a)
What information from the patient record is effectively accessed and what data is entered during the daily round on a normal ward?
- (b)
What are the statistics and typical sequences of data access and entry?
To our knowledge this information has not been assessed in the literature. In our study, physicians were observed during their daily round at hospital and interviewed after the round, to get additional qualitative information. We first describe our study design and the methods used. We then present the results, discuss them and conclude on the basis of our findings with design suggestions for a mobile CPR system.
Section snippets
Study design and methods
The study was performed in a middle-sized Swiss hospital (270 beds), where a computerized patient record system has been used on workstations since September 2001. At the time of our investigation, the implemented CPR included administrative patient data and the medical record. The nurse’s record was not yet computerized, i.e., this part of the patient record is still completely paper-based. During their round, physicians used a printed version of the CPR together with the paper-based nurse’s
Results
The aim of our study was to find the physicians’ needs when they interact with the patient records in the context of the daily round. The work at the point of care is under time pressure and quite hectic. Thus, physicians interacted very briefly with the patient record and accessed it to either request or enter information. We first describe the physician’s access interaction with the record and then present our findings concerning data entry during the round.
Discussion
Our study was performed in a real setting at a hospital and dealt with the physicians’ use of patient records in the context of the daily round. The investigation aimed to analyze the paper-based working routines in real time with the purpose of obtaining input for the design of a user interface for a mobile CPR system.
The observation method was chosen so that the working process was not disturbed. We recorded the access interaction with a compact shorthand notation and never intervened in the
Conclusion
In the context of the daily round, the mobile CPR system should support the physician with a complete patient record and ensure an efficient and effortless interaction. Physicians have clear access preferences. Almost 50% of all patient record accesses concern information about medications, vital signs and requests of laboratory tests. The design of the CPR user interface should consider this access behaviour. It should be streamlined accordingly to ensure an efficient and easy handling.
Our
Acknowledgements
We would like to express our sincere thanks to the staff of the hospital Stadtspital Waid in Zurich for their friendly support of this study, to Fred Damberger and Rochus Keller for their critical review of the manuscript and comments and to the company SEC1.01 in Aarau, Switzerland, for financial support of this work.
References (22)
- et al.
Reading the medical record I
Comput. Methods Programs Biomed.
(1992) - et al.
Mobile information and communication tools in the hospital
Int. J. Med. Inf.
(2000) - et al.
Mobilizing a health professional’s workstation—results of an evaluation study
Int. J. Med. Inf.
(1999) - et al.
Major issues in user interface design for health professional workstations: summary and recommendations
Int. J. Biomed. Comput.
(1994) - et al.
Integrating users’ activity modeling in the design and assessment of hospital electronic patient records
Int. J. Med. Inf.
(2001) Patient care information systems and health care work: a sociotechnical approach
Int. J. Med. Inf.
(1999)- et al.
Medical narratives in electronic medical records
Int. J. Med. Inf.
(1997) The computerized patient record: balancing effort and benefit
Int. J. Med. Inf.
(2002)- et al.
An experimental electronic patient record for stroke patients. Part 1: situation analysis
Int. J. Med. Inf.
(2000) - J.D. Howell, Technology in the Hospital, Transforming Patient Care in the Early Twentieth Century, Johns Hopkins...