Building an inter-organizational communication network and challenges for preserving interoperability
The ideal scenario for information technology to bridge information gaps between primary and secondary healthcare and to improve the quality of healthcare in the medication process is to build an interoperable communication network. This type of undertaking requires diverse information systems to be integrated, and central to this are the preservation of data integrity and the integration of different pieces of patient data. OBJECTIVES AND METHODOLOGY: In this study, we focused on sources of challenges to the integration process and to the building of an interoperable communication network. Interviews, document analysis, and observations were conducted to evaluate the integration process in a project that involved medication data communication between primary healthcare providers (i.e., general practitioners and community pharmacists) and secondary healthcare providers (i.e., hospital pharmacists and specialist physicians). The project encountered numerous integration problems, many of which persisted even after extensive technical intervention. An analysis of the problems revealed that they were mostly rooted either in problematic integration of work processes or in the way the system was used. Despite the project's ideal technical condition, the integration could be accomplished only by applying human interfaces. The main challenge to building interoperable communication network does not lie in technical integration. The real problem occurs when the technical linkage is implemented without the work processes being aligned and integrated.
[Show abstract] [Hide abstract] ABSTRACT: The design and implementation of an electronic medical record system pose significant epistemological and practical complexities. Despite optimistic assessments of their potential contribution to the quality of care, their implementation has been problematic, and their actual employment in various clinical settings remains controversial. Little is known about how their use actually mediates knowing. Employing a variety of qualitative research methods, this article attempts an answer by illustrating how omitting, editing and excessive reporting were employed as part of nurses' and physicians' political efforts to shape knowledge production and knowledge sharing in a technologically mediated healthcare setting.
- "physician communication (Aarts and Koppel 2009, Berner et al. 2005, Harrison et al. 2007, Niazkhani 2007, Pirnejad et al., 2008b, Vaaste 2007). And so, the pragmatics of how to manage the highly cognitive, collective and ad hoc nature of medical work remains a persistent concern. "
[Show abstract] [Hide abstract] ABSTRACT: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.
- "One of the major design challenges identified related to lack of consistency in information layouts and limited considerations of information semantics in the system design. Striving for information consistency in health care settings is not only a problem of technical integration, but also of aligning inter-organisational work processes343536. Achieving the right degree of information consistency therefore requires input from all stakeholders about residents' medication information to negotiate how to stabilise the content and meaning of coordinative artefacts like medication charts [35,37,38]. "
[Show abstract] [Hide abstract] ABSTRACT: This study formulates and empirically tests a theoretical model involving factors in the use of mobile devices for knowledge sharing in hospitals. The research model is derived from two important studies, Kankanhalli et al.'s (2005a, 2005b) studies on electronic knowledge repositories, and is adapted to the healthcare context. We conduct an exploratory case study of three mobile devices in two units of a hospital. The preliminary results reveal that factors such as image, privacy, reciprocity, quality of output, resource availability and portability influence the use of these devices for knowledge sharing.
- "Healthcare IT systems, especially mobile tools, can enhance such environments. However, many healthcare professionals remain reluctant to embed these tools in their medical practices (e.g. Pirnejad et al., 2008; Protti et al., 2007). Much of their work must be carried out quickly, and is completed away from their offices, so the need to frequently interact with technology, especially fixed workstations, can be resisted. "