Marburg University Medical Center has been introducing a comprehensive health information system since 1999, using a single-vendor application framework with an integrated generator tool for the development of clinical applications. To find out if this architecture and our participative software engineering approach can be considered a step towards a responsive infrastructure, we compared the situation after the first deployment phase (basically a holistic approach) with the situation after the system was further developed and adapted to the users' needs using the generator tool approach. We collected system statistics and conducted user satisfaction surveys in 2001/02 and 2003 using standardized measurements. The survey results showed that user involvement as well as system content were judged significantly higher after the second deployment phase. Insofar, we could demonstrate the feasibility of our approach. However, definite statements concerning the superiority of the generator tool approach to other concepts are not yet possible. We will continue our assessment, and we strongly suggest further studies in other institutions introducing comparable clinical functionality.
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