IT IN THE EMERGENCY DEPARTMENT

What is the Impact of Technology?

Haleh Ayatollahi

1,2

, Peter A. Bath

and Steve Goodacre

Health Informatics Research Group, Department of Information Studies, University of Sheffield

Regent Court, 211 Portobello Street, Sheffield, U.K.

Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran

Emergency Department, Northern General Hospital, Herries Road, Sheffield, U.K.

Keywords: Emergency Department, information system, impact.

Abstract: Emergency Department Information Systems (EDIS) are commonly used to improve access to patient

information at the point of care. While such systems hold great promise, there has been little research

evaluating the impact of these systems. To investigate the Emergency Department (ED) staff perceptions of

the impact of computerised information systems in this department, a qualitative study was conducted. In

this study, data were collected using in-depth semi-structured interviews with the ED staff. In total, 34

interviews were conducted and data were analysed using framework analysis. . The results showed that the

impact of information systems could be categorised as individual impact, organisational impact, and impact

on patient care. The impact of technology could be positive (e.g., improving the accessibility of

information) or negative (e.g., interrupting staff workflow due to system downtime). The results suggest

that although clinical information systems are designed to influence clinical practice positively, the

likelihood of the negative impacts should not be underestimated. Evaluation studies are needed to

investigate the impact of technology as a measure for system success or failure.

1 INTRODUCTION

In recent years the use of information technology in

Emergency Departments (EDs) has increased, due to

attempts to improve the accessibility of information,

reduce errors in clinical practice, eliminate

documentation errors, and to improve the

completeness of data (Harper, 2001). However, the

implementation of new technology into a complex

environment, such as an ED, may result in

unforeseen consequences, such as negative effects

on clinical practice (Embi et al., 2004). For

example, an increase in the amount of time that is

spent on a computer and a reduction in the time

spent on caring for patients, or a lack of fit between

the system features and users’ work may all have a

negative impact on clinical practice (Rose et al.,

2005).

A number of evaluation studies have been

undertaken to explore the impact of information

systems in different settings; however, little has been

reported about the impact of using information

technology in the ED. Since the ED has special

characteristics in terms of the variety of patients and

the speed of work (Amouh et al, 2005), investigating

users’ perceptions of the impact of computerised

information systems could help to identify factors

that may influence the success or failure of systems.

This can be also useful for developing and

implementing information systems in the future.

The aim of the present study was to investigate

users’ perceptions of, and interactions with EDIS.

The objectives were to identify issues that might

influence the use of EDIS, and to compare users’

perspectives about these issues.

2 METHODS

This was a qualitative study conducted in March-

April 2007. A qualitative approach was applied to

gain a better, and in-depth, understanding of the

context, and factors that might influence the use of

information systems in the ED. The research setting

454

Ayatollahi H., Bath P. and Goodacre S. (2009).

IT IN THE EMERGENCY DEPARTMENT - What is the Impact of Technology?.

In Proceedings of the International Conference on Health Informatics, pages 454-457

DOI: 10.5220/0001539504540457

 SciTePress

was an ED located in a large urban teaching hospital

in northern England. The ED in this hospital is

particularly busy as it is the only major one in the

city responsible for providing emergency care for

adult patients. In this department, paper-based

records are used as the main source of information

(e.g. medical records, patient notes, ED cards).

However, the ED’s electronic information systems

include a Patient Focus Information System (PFIS),

a patient tracking system, and a Radiology

Information System, although these are not

integrated with each other. The access level is

different for different user groups.

In order to collect data, semi-structured

interviews were chosen as the most appropriate

method, as the aim of the study was to investigate

users’ perceptions. This would help to gather more

in-depth data. In this study, convenience sampling

was used to recruit the participants. However, in

order to have a broader picture of users’ perceptions,

different members of staff who used the information

systems were interviewed. The interviews were

digitally recorded (with the participants’ consent)

and were transcribed verbatim. To analyse the

interview data, the method of framework analysis

was used (Ritchie and Spencer, 1994). In this study,

data were analysed by one of the researchers (HA),

and to facilitate coding data, computer software

QSR NVIVO 7 was used. In order to check the

validity of results, member checking was used and

the interviewees asserted the accuracy of the results.

3 RESULTS

Thirty-four ED members of staff were interviewed

in total. The interviews lasted between 20 and 70

minutes (mean = 43 minutes). The participants of

the study were the ED staff (Doctors, Nurses, and

Administrative staff) who used at least one of the

information systems in the ED. Nine participants

were male and 25 were female. The age range was

25 to 57 years old.

A key theme that emerged from the data analysis

was the perceived impact of IT. The results

suggested that the impact of IT could be sub-divided

into individual impact, organisational impact, and

impact on patient care.

3.1 Individual Impact

The results suggested that if the ED staff were asked

to use a new computerised information system, some

of them might experience feelings such as fear,

stress, and nervousness. Such feelings could mostly

be experienced when a change happened in their

work practices, for instance, when they had to enter

data into the computer rather than writing it on

paper. In relation to this, a doctor said:

‘I have never used a fully computerised system,

so I am still a little bit nervous about that, I think my

nervousness, from the bits that I have used has gone’

[Doctor 10].

Some interviewees mentioned that, not only in

the early stages of introducing a new system, but

also after getting used to using it, any problem with

the system, such as system downtime could make

them ‘panic’.

‘If the system goes down, you are absolutely lost

because you can’t look for anything. You know, you

are hopeless’ [Administrative staff 1].

From the users’ perspectives, the positive

impacts were mainly associated with having easier

and quicker access to the information that they

needed. This could help the clinicians to provide

patients with a better care plan in a timely fashion.

As a doctor noted:

‘…, it would make the day run much more

smoothly, so you go home without having to worry

about you have tried to guess some’ [Doctor 8].

In terms of the negative impacts, although most

of the interviewees believed that the current ED

systems were easy-to-use, some of them

remembered that using these systems at the

beginning affected their work negatively.

‘The tracking system, when they first introduced

it, you spent your time treating the tracking system

and not treating patients’ [Doctor 10].

‘…, we didn’t like it (patient tracking system)

when we first started it, because we thought it was

an extra job we weren’t supposed to,…’

[Administrative staff 8].

In fact, a lack of fit between the staff work flow

and the way that the system worked could be a

reason for this negative impact.

3.2 Organisational Impact

As some of the staff were responsible for managerial

tasks in the department, using computerised

information systems could also facilitate their jobs.

The accessibility of information helped them to

make better decisions at the departmental and

organisational level. As a doctor noted:

‘It has completely changed how we work really.

I can pick up doctors who are failing for various

reasons… you can look at the doctors who x-ray

every single patient that they see’ [Doctor 10].

IT IN THE EMERGENCY DEPARTMENT - What is the Impact of Technology?

455

The accessibility of information had, in turn,

helped to increase efficiency in the department. The

use of information systems had also improved data

communication in the ED. For example, the ED

staff could use the patient tracking system to add

notes regarding a patient’s status, and the rest of the

ED staff could be informed about that by using the

system. With reference to this, a nurse commented:

‘That computer (patient tracking system) helps

us to communicate by putting information on that’

[Nurse 8].

However, most of the interviewees mentioned

that system downtime had a significant negative

impact on their work since they could not have

access to information that they needed. This

situation was a ‘nightmare’ and caused ‘chaos’, as

mentioned by several interviewees.

3.3 Impact on Patient Care

This sub theme included the positive, neutral, and

negative impact of using information systems on

patient care. Most of the interviewees agreed that

the use of information systems had a positive impact

on patient care, mainly in terms of improving the

speed of care and saving time for clinical tasks,

reducing clinical error, increasing effectiveness, and

improving patient safety.

‘…, you would reduce the risk of things like one

patient’s x-ray being put in another patient’s packet.

So, it would reduce the risk of any incident and

possibly it would reduce the negligence cases’

[Nurse 5].

A number of participants indicated that

information systems could improve the accessibility

of information and the more information they had,

the better and quicker were the clinical decisions

made.

While most of the interviewees stated that using

information systems had a positive impact on patient

care and could improve it, a few of the interviewees

asserted that using information technology had no

effect on patient care:

‘It usually speeds things up for beds and

provides the methods of doing order, research and

something, because you have got data available.

But, it doesn’t affect the individual patient care very

much, I don’t think’ [Doctor 4].

Moreover, some of the interviewees were

concerned about the negative impacts of information

systems on patient care. From their point of view,

system characteristics that might cause them to

spend too much time on a computer rather than on

patient care, or the low quality information on the

systems, could adversely affect patient care.

‘If it (a computerised information system) is too

time-consuming to put in the information, then that

may be detrimental to the patient care’ [Nurse 5].

These results suggest that not only the technical

aspects of a system (e.g., hardware and software)

should be taken into account, but also the non-

technical aspects, such as data quality, need to

receive adequate attention.

4 DISCUSSION

Clinical information systems are mainly designed

and implemented to improve efficiency,

effectiveness, and the quality of patient care in the

healthcare settings. While these systems are

expected to meet their targets, a number of technical

and non-technical reasons may result in adverse

effects.

Regardless of being positive or negative, the

impact of computerisation has been categorised in

several studies. For example, van der Meijden et al.

(2003) focused on the individual and organisational

impacts of computerisation. From their perspective,

the individual impacts attributes included changed

clinical work patterns, changed documentation

habits, efficiency and effectiveness of work. The

attributes of the organisational impact included

communication and collaboration, impact on patient

care and cost. Despont-Gros et al. (2005, p. 251)

concentrated on the impact of computerisation from

a user’s point of view. The authors suggested that

the impact of computerisation can be categorised

either as ‘real impacts’, such as a change in

communication patterns or workflow or as

‘perceived impacts’ such as a feeling of being

controlled or stressed to work in a standardised way.

Raitoharju (2005) focused on IT-related stress as one

of the individual impacts of computerisation.

The results of the current study suggest that, in

order to investigate the impact of clinical

information systems, a combination of the above-

mentioned areas should be taken into account. In

terms of the individual impact of technology, it is

notable that the nature of working in a healthcare

setting, particularly in the ED, may be stressful for

the staff (Raitoharju, 2005). Hence, it is important

to understand how their IT-related stress can be

reduced or eliminated, rather than adding to their

work stress. According to the results, as introducing

a system to a work environment may have a negative

impact at the beginning, ongoing training in the use

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of the system and more communication with users

should be considered to improve their understanding

of the system (Campbell et al., 2006).

The impact of using information systems on

patient care seemed to be an arguable issue.

However, it seems that a system that is able to meet

clinicians’ expectations can help them to make better

decisions, and can help to improve patient care.

Overall, the results suggest that, from the user’s

perspective, the systems’ benefits far outweighed

any negative effects, and none wanted to give up the

systems. In order to reduce the potentially negative

impact of using technology, before designing and

implementing information systems the current

workflow should be investigated and re-designed if

necessary.

5 LIMITATIONS OF THE STUDY

In this study, data were collected from only one

Emergency Department where specific information

systems were used. As a result, the findings may not

be fully transferable to other settings in which other

systems are in use. In addition, our sampling

method was limited by the need to fit in with staff

working patterns, so we had to use convenience,

rather than purposive, sampling. However, the

results could be useful for developing and

implementing clinical information systems,

particularly in the Emergency Department, in the

future.

6 CONCLUSIONS

In this paper, we showed that the use of clinical

information systems might affect three main aspects:

the users, the organisation, and patient care. While

the positive impact of technology suggests that a

system has been successful in achieving its intended

goals, the negative effects should be lessons learned

for future developments. Care should be taken when

designing and implementing such systems to avoid,

or at least minimise, any potentially harmful effects.

Further research is needed to assess the extent of the

effects identified in this study among different user

groups, and in other EDs or hospital departments

with similar characteristics.

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