Abstract

Background
In the context of Health IT the regions in Denmark have decided that each region operates with one regional EPR system only. Due to this decision Region Midtjylland is in the process of implementing a common regional EPJ (MidtEPJ) that soon will be in use in all the hospitals in Region Midtjylland. It is a difficult task to make the users of EPJ to document in such a manner that information about the patient can be reused, retrieved and recognized if the patient is hospitalized in a different ward or hospital. The starting point of this study was then to explore which factors that are of significance if the practice of documentation is to be unified in Region Midtjylland.

Method
Qualitative interviews were used as a method of exploration. The interviewed are important parts that have different interests in the problem and highlight particular factors that are of significance in regard to unify the practice of documentation in the region. The results of the interviews are analysed by systematic text condensation and subsequently analysed within the theoretical frames of management of change (Kotter) and Social Construction of Technology (Bijker).

Results
The study identified several factors that are of significance to the establishment of a common practice of documentation in the hospitals in Region Midtjylland. The most important factors are: lack of consent regarding terminology, different working procedures, workarounds to work in the system, delayed handling of cases in the regional groups for unification of documentation practice, and important parts that have different interests in documentation. Furthermore, no interest of how documentation was practiced elsewhere was shown and the applied practice of documentation was not passed on to others either. The EPJ organisations in the hospitals are not visible and management involvement is needed before the practice of documentation can be changed.

Conclusion
The study indicates several problems in regard to unifying documentation. Among other things it is relevant to explore if the EPR organisations in each hospital are geared to ensure ensure consistent documentation and if the applied strategies for problem solution are appropriate. The study also emphasized that focus primarily rests on singular wards of personal interest. All though MidtEPJ is to be a common regional EPJ system there is no interest in how others in the organisation documents. It is however questionable to which extend terminology and working procedures can be unified and standardized in all the hospitals in Region Midtjylland.