Impact of information technology on health care professionals and patient care : a multiple case study in community hospitals
Creators: name: Hebert, Marilynne Arlayne
Publisher: name: University of British Columbia
Year: 2009

description: The purpose of this study was to investigate two questions: 1) What, i f any, is the perceived difference in impact of Patient Care Information Systems (PCIS) on health care professional groups in hospitals? 2) What factors explain such perceived differences in impact among these groups? A multiple-case methodology was used as this approach permitted factors within the organizational context to be considered. Four professional groups participated in the study, including laboratory technologists, pharmacists, nurses and physicians. They were located in five community hospitals in British Columbia that had achieved various levels of PCIS implementation. From the literature review an analytic framework based on successful information technology (IT) in other industries was developed to investigate impact. To more closely reflect the goals of IT in the health care setting, the framework was adapted by using Donabedian's (1988) three measures of quality (structure, process, outcome). For each participant group these measures were examined at Grusec's (1986) three levels of impact: substitution, proceduralization and new capabilities. Three types of data were collected: interviews, document review and observation. Eighty-five semi-structured interviews were conducted and a selected number of participants were observed using the PCIS. Written documentation and archival material relevant to the adoption and use of the PCIS were reviewed for each site. These included IT proposals, strategic IT plans, task force and steering committee minutes, internal and external correspondence. The data were analyzed manually and with textbase management software called FolioVIEWS® 3.1 for Windows. This software facilitated the searching of interview transcripts in ways defined by the investigator and building hypertext linkages in the data. The study findings include differences across hospitals and groups. The hospitals are community based and differ on one important variable: the extent of PCIS implementation. Differences are expected to be related to this variable. Generally this is true, as Hospitals 1 and 2 demonstrate more evidence of impact in structure at levels 1 and 2 for all groups. As expected, Hospitals 4 and 5 do not demonstrate this level of impact. However, unexpectedly these two hospitals are able to identify specific evidence of linkage between the measures of structure, process and outcome. Five themes emerge that illustrate the perceived differences among the professional groups with respect to the impact of PCIS use. The first theme relates to increased efficiency and productivity that result from automating clerical tasks, particularly sending and receiving orders. This theme relates more to pharmacists and laboratory technologists as changes in structure take place when their tasks are automated. The second theme relates to role and responsibility changes, particularly those experienced by nurses and physicians. This is partly due to the expected changes in process (e.g. decision-making) arising from changes in structure (e.g. faster lab results). Role changes also occur when technology can be used by one group to accomplish tasks formerly completed manually by another group. For example, historically physicians write orders on paper charts and unit secretaries transcribe those orders onto paper requisitions, which are then sent to the appropriate department. Nurses are responsible for ensuring this is done correctly and the results forwarded to physicians as needed. When physicians or nurses enter orders directly into the computer, all three roles change. The participants are unable to identify how they expect these changes to unfold. "Visible" accountability is a change experienced by all four groups. For laboratory technologists and pharmacists this change occurs primarily in measures of structure. Automating tasks such as reporting results or medication profiles creates an electronic audit trail that documents the volume and accuracy of work accomplished (e.g., the number of orders processed, number of errors). For nurses and physicians, this change occurs in the process measures as decisions with respect to care are recorded and immediately available for inspection by other professional groups. All four groups experience unexpected consequences of electronic communication. The levels of electronic mail (e-mail) use varies by system availability in each hospital and demonstrates changes in structure. This medium replaces a paper-based system as well as supports new opportunities for committee and group work through multiple access to single documents. Participants predict other uses in use of on-line clinical practice guidelines and interdisciplinary documentation of patient care. The fifth theme, training to use technology versus learning to use information, suggests that users must be able to do more than simply "use the technology" to achieve the potential benefits. This affects pharmacists, nurses and physicians in particular as they attempt to determine linkages between structure, process and outcome. The study contributes to understanding the impact of IT in health care by identifying where differences between professional groups in community hospitals occur. The study concludes that linkages between structure and process or process and outcome must be determined before users can expect the computer system to have the intended effect. One example of this is when changes in the work of laboratory technologists and pharmacists (structure) is expected to change the work of nurses and physicians (process). Use of IT also creates role and responsibility changes that contribute to its impact.