• Jan Bossow
  • Else Lund Pedersen
3 year, Master of Health Informatics (Continuing education) (Continuing Education Programme (Master))
Background Getting an overview of the patient is a phrase which traditionally is used very much by doctors and nurses in connection with clinical work. This work is by nature "distributed" that means that treatment of patients is distributed on many different clinicians. That implies that the clinical information of the patients - including that information which can be found in the journal (Electronic Patient Record or paper) must be acquired all the time by the individual doctor or nurse. A good deal of the clinical work thus deals with updating in relation to the state of the patient's illness, including the patient's symptoms, possible side effects, results from blood samples, examinations etc. In a report from 2006 concerning ward rounds the clinical overview is among other things described as a form of information whose aim is to cause order, and control and organise the clinical work as well. The process of getting an overview is based on physical presence in the ward, a close contact with the patient, and an updated information of the patient's medical record. In connection with the implementation of the EPR in Denmark the ambition has also been to make an EPR which in combination with other IT-systems can help the clinician to get the optimum overview of the patient's data. The ambition, however, has not been quite fulfilled being that the issue of making an overview comprises a good deal of the debate concerning the EPR. The criticism has particularly come from the medical side, and evaluation reports from several EPJ-projects have pointed out different approaches to the problem. At many places the paper journal is still in use and contains relevant clinical information. As a paradox to the extensive debate on overview in the electronic patient record studies have shown that much of the information which the clinicians acquire in connection to getting an overview of patient data comes from mono and interdisciplinary colleagues. Studies have shown that only about 10 percent of the information is gathered from electronic clinical information systems. Scope The scope of this project is to impart an understanding of the clinical process of getting an overview for nurses and doctors in the light of a health informatics perspective. The idea of the project stems from our initial wondering about the intense focusing on the overview problem related to the EPR. Realising that clinical work is a complex matter and at the same time also realising the present immaturity of information technology when it comes to clinical work we will explore the clinical process of making an overview for doctors and nurses at a somatic hospital ward in connection with the EPR and other artefacts. The object of this project is to illustrate how the clinicians use the EPR as regards to the clinical process of getting an overview in a mono and interdisciplinary context. Method: An etnographically inspired observation study has been made at two wards at the same hospital in Denmark where a 1st generation EPR has been implemented. A total of 12 observations have been made: 6 of nurses and 6 of doctors. The non-participating observer has followed the clinician around the ward in connection with his/her duties on a normal working day. The observations have also included the interaction with colleagues, mono and interdisciplinarily, and in relation to the patients. The observer has made use of a digital dictaphone and dialogues/conversations have been recorded as they have taken place among the clinicians in regards to Abstract reporting and ward rounds. To support the recordings field notes were taken. As to the clinicians' use of the EPR we have registrated the use of various screen prints. Conclusion and putting into perspective - Using solely the EPR as an artefact for the clinician in the process of getting an overview in relation to the clinical work is not sufficient by it self. - The lack of maturity of the technology (EPR) affects the EPR as a tool in the clinician's process of getting an overview. - Lack of optimisation of work processes has an influence on the use of the technology (EPR) in the process of getting an overview.
Publication date2006
Number of pages131
Publishing institutionAalborg Universitet
ID: 6139683