The use of computers for clinical care: a case series of advanced U.S. sites

Abstract

Objective: To describe advanced clinical information systems in the context in which they have been implemented and are being used.

Design: Case series of five U.S. hospitals, including inpatient, ambulatory and emergency units. Descriptive study with data collected from interviews, observations, and document analysis.

Measurements: The use of computerized results, notes, orders, and event monitors and the type of decision support; data capture mechanisms and data form; impact on clinician satisfaction and clinical processes and outcomes; and the organizational factors associated with successful implementation.

Results: All sites have implemented a wide range of clinical information systems with extensive decision support. The systems had been well accepted by clinicians and have improved clinical processes. Successful implementation required leadership and long-term commitment, a focus on improving clinical processes, and gaining clinician involvement and maintaining productivity.

Conclusion: Despite differences in approach there are many similarities between sites in the clinical information systems in use and the factors important to successful implementation. The experience of these sites may provide a valuable guide for others who are yet to start, or are just beginning, the implementation of clinical information systems.

Figure 1.

Excerpt from the Data Collection Survey

Figure 2.

Proportion of computerized orders directly entered by physicians^{*†‡ *}The percentages refer to the proportion of direct physician entry of computerized orders, not the proportion of direct physician entry of all computerized and noncomputerized orders. ^†LDSH physicians entered total parental nutrition and one-third of blood orders on the inpatient units and one-third of blood orders in the emergency department (apart from one ICU, in which they also ordered anti-infective agents and ventilator settings). Therefore, 1% direct physician entry has been used in both these situations for illustrative purposes. ^‡At QMC inpatient units the overall proportion of direct physician entry of computerized orders was 62%, although proportion of direct entry for residents was 80%. (Attending physicians entered majority of tests and proportion of direct entry by them was 48%.)