The impact of mobile handheld technology on hospital physicians' work practices and patient care: a systematic review.

The substantial growth in mobile handheld technologies has heralded the opportunity to provide physicians with access to information, resources, and people at the right time and place. But is this technology delivering the benefits to workflow and patient care promised by increased mobility? The authors conducted a systematic review to examine evidence regarding the impact of mobile handheld technology on hospital physicians' work practices and patient care, focusing on quantification of the espoused virtues of mobile technologies. The authors identified thirteen studies that demonstrated the ability of personal digital assistants (PDAs) to positively impact on areas of rapid response, error prevention, and data management and accessibility.

Mobile and fixed computer use by doctors and nurses on hospital wards: multi-method study on the relationships between clinician role, clinical task, and device choice.

Background: Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions.

Objective: We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards.

Development and testing of an observational method for detecting medication administration errors using information technology.

One-third of medication errors that cause patient harm arise from medication administration errors (MAEs). Research regarding rates of MAEs is limited and has predominantly relied upon voluntary incident reports or observational studies. Traditionally, observational studies have used paper-based data collection.

Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review.

Previous reviews have examined evidence of the impact of CPOE on medication errors, but have used highly variable definitions of "error". We attempted to answer a very focused question, namely, what evidence exists that CPOE systems reduce prescribing errors among hospital inpatients? We identified 13 papers (reporting 12 studies) published between 1998 and 2007. Nine demonstrated a significant reduction in prescribing error rates for all or some drug types.

Safety and efficiency considerations for the introduction of electronic ordering in a blood bank.

The introduction of computerized provider order entry (CPOE) systems is associated with major changes in work processes. Implementation strategies need to consider how the technology will affect and be affected by the organization in which it is being installed. The aim of this study was to examine the potential effect of the introduction of a CPOE system on key work processes in a hospital blood bank by using qualitative data from focus groups, interviews, and participant observation and quantitative data of telephone communication.

Test turnaround times and mortality rates 12 and 24 months after the introduction of a computerised provider order entry system.

Objectives: Few studies have measured the long-term effects of computerised provider order entry systems on pathology test turnaround time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to system introduction in a major Australian teaching hospital: i) are improvements in turnaround times achieved in the first 12 months after system introduction sustained 24 months post-implementation; and ii) do mortality rates change following the introduction of an order entry system?

Methods: Turnaround time and mortality rates 5 months before and 12 and 24 months after implementation of a computerised order entry system were measured.

The importance of medical and nursing sub-cultures in the implementation of clinical information systems.

Objective: To measure doctors' and nurses' perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use.

Methods: A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital.

Computerized Provider Order Entry--what are health professionals concerned about? A qualitative study in an Australian hospital.

Purpose: To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management.

Methods: The study was conducted in a large Australian teaching hospital using semi-structured interviews (n=20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers.

Social network analysis of medication advice-seeking interactions among staff in an Australian hospital.

Purpose: To examine the medication advice-seeking network of staff in a hospital ward.

Methods: Social network analysis was carried out in a renal ward of an Australian metropolitan teaching hospital. The medication advice-seeking interactions of doctors, nurses, allied health professionals (including a pharmacist) and a ward clerk were examined using data from questionnaires administered to staff.

Design, application and testing of the Work Observation Method by Activity Timing (WOMBAT) to measure clinicians' patterns of work and communication.

Background: Evidence regarding how health information technologies influence clinicians' patterns of work and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. The use of electronic data collection tools for such studies is emerging yet is rarely assessed for reliability or validity.

Clinical decision velocity is increased when meta-search filters enhance an evidence retrieval system.

Objective: To test whether the use of an evidence retrieval system that uses clinically targeted meta-search filters can enhance the rate at which clinicians make correct decisions, reduce the effort involved in locating evidence, and provide an intuitive match between clinical tasks and search filters.

Design: A laboratory experiment under controlled conditions asked 75 clinicians to answer eight randomly sequenced clinical questions, using one of two randomly assigned search engines. The first search engine Quick Clinical (QC) was equipped with meta-search filters (the combined use of meta-search and search filters) designed to answer typical clinical questions e.

Impact of an ultrabroadband emergency department telemedicine system on the care of acutely ill patients and clinicians' work.

Objectives: To evaluate whether introduction of an emergency department (ED) telemedicine system changed patient management and outcome indicators and to investigate clinicians' perceptions of the impact of the system on care provided and on their work.

Design: Before-and-after study of use of the Virtual Critical Care Unit (ViCCU), which uses an ultrabroadband connection allowing real-time audiovisual communication between clinicians at distant sites. Semi-structured interviews were conducted with medical and nursing staff at the end of the study.

Computerised order entry systems: sustained impact on laboratory efficiency and mortality rates?

Few studies have attempted to measure the effectiveness of computerised test-order entry systems to reduce test turnaround time and the extent to which improvements are sustained or continue over time. Further, a recent study has raised the possibility that such systems, which require significant work practice change, may be associated with an increase in mortality rates. Our study answered two questions in relation to the introduction of a computerised pathology order entry system in a major Australian teaching hospital: i) are initial improvements in turnaround times achieved in the first 12 months of system use sustained beyond this time; and ii) did mortality rates change following the introduction of the order entry system? We found significant improvements in turnaround times 12 and 24 months following system implementation and no change in average number of tests per patient.

The use of performance metrics to monitor the impact of CPOE on pathology laboratory services.

Organisational communication perspectives provide a framework for examining the impact of new Computerised Physician Order Entry (CPOE) systems on health care organisations. The aim of this study was to utilise performance metrics (volume of telephone/fax calls and the management of unfulfilled test requests) as a way of monitoring the impact of a new CPOE system on the communication (synchronous and asynchronous) interface in the Central Specimen Reception (CSR) area of a pathology laboratory service. The total number of outgoing and incoming calls rose considerably after the implementation of the new system.

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time.

Objective: To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients.

Design: Observational time and motion study.

Setting: 400-bed teaching hospital in Sydney.

Long-term patterns of online evidence retrieval use in general practice: a 12-month study.

Background: Provision of online evidence at the point of care is one strategy that could provide clinicians with easy access to up-to-date evidence in clinical settings in order to support evidence-based decision making.

Objective: The aim was to determine long-term use of an online evidence system in routine clinical practice.

Methods: This was a prospective cohort study.

Contextual implementation model: a framework for assisting clinical information system implementations.

Objective: This paper presents a multiple perspectives model of clinical information system implementation, the CONTEXTual Implementation Model (CIM). Although other implementation models have been developed, few are grounded in data and others fail to take adequate account of the clinical environment and users' requirements.

Design: The CIM arose from qualitative data collected from four clinical units in two large Australian teaching hospitals.

The medication advice-seeking network of staff in an Australian hospital renal ward.

Electronic medication systems may impact communication in hospital wards. To identify the ways in which communication patterns may be altered it is necessary to compare processes both before and after system introduction. This paper reports the use of a social network approach to examine the medication advice-seeking network of an Australian hospital renal ward before the introduction of an electronic medication management system.

Measuring nurses' time in medication related tasks prior to the implementation of an electronic medication management system.

A substantial proportion of nurses' work consists of medication related tasks undertaken in a current environment of high medication error rates. Electronic medication management systems (EMMS) are anticipated to address many of the factors which contribute to errors. These factors, for example illegible hand-written drug orders, reputedly require nurses to spend additional time in clarification and discussion.

Pathology's front line - a comparison of the experiences of electronic ordering in the clinical chemistry and haematology departments.

Socio-technical approaches to health information systems evaluation are particularly relevant to the study of Computerised Provider Order Entry (CPOE) systems. Pathology services are made up of a number of departments each with unique and complex tasks and requirements. These different components of pathology have received very little research attention.

Methods for measuring the impact of health information technologies on clinicians' patterns of work and communication.

Evidence regarding how health information technologies influence clinical work patterns and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. Our objective was to design and test an electronic data collection tool for work measurement studies which would allow efficient, accurate and reliable data collection, and capture work complexity.

Using an accident model to design safe electronic medication management systems.

Large-scale implementation of electronic prescribing systems (e-PS) is likely to introduce at least some machinerelated errors that will harm patients. We present a dynamic systems modeling approach to developing a comprehensive multilevel accident model of the process, context and task interaction variables which give rise to human error and system failure when e-PS are used in routine care. System dynamics methods are used to represent interactions between medication management processes and the context that is relevant to error generation, interception and transmission, agent-based methods represent task interactions.

An action research protocol to strengthen system-wide inter-professional learning and practice [LP0775514].

Background: Inter-professional learning (IPL) and inter-professional practice (IPP) are thought to be critical determinants of effective care, improved quality and safety and enhanced provider morale, yet few empirical studies have demonstrated this. Whole-of-system research is even less prevalent. We aim to provide a four year, multi-method, multi-collaborator action research program of IPL and IPP in defined, bounded health and education systems located in the Australian Capital Territory (ACT).