Anvendelse af informationsdesign i den elektroniske patientjournal

Abstract

Resume Med indførslen af de elektroniske patientjournaler i Danmark, tales der ofte om hvor svært det er for det sundhedsfaglige personale at danne sig et overblik over patienternes data og informationer. Dette er ikke et isoleret fænomen for Danmark, men har også vist sig at være problematisk i andre internationale tiltag. En af de store målsætninger med implementering og udvikling af EPJ, er netop at lette klinikerne i deres arbejde, men denne målsætninger er endnu ikke opnået i tilstrækkeligt omfang. Vi undrer os over hvad der er af bagvedliggende årsager til at dette endnu ikke er lykket. Problemformuleringen lyder: ”Hvilke krav er der til et informationsdesign, for at informationer i den elektroniske patientjournal kan præsenteres så klinikeren bliver understøttet i deres dannelse af overblik over den enkelte patient?” Formålet med projektet er at se på hvilke informationer klinikerne har behov for i deres dannelse af det kliniske overblik og samtidig se på hvilke faktorer, som påvirker deres overbliksdannelse. Projektrapporten belyser denne problemstilling via en række interviews af klinikere der til dagligt arbejder med en EPJ. Metodemæssigt er der anvendt Steinar Kvale’ kvalitative interview teknikker og Grounded Theory, som beskrevet af Glaser & Strauss og senere udviklet af bl.a. Charmaz og Guvå & Hylander. Dataanalysen indeholdt et råmateriale på ca. 1000 indikatorer, som er klassificeret og kodet, med anvendelse af mindmapping til at støtte analysen. Dette har resulteret i en kerneproces kaldet ’Dannelsen af det kliniske overblik’ og fire tilhørende processer. Med udgangspunkt i disse processer har vi skabt en teori, som efterfølgende er blevet udsat for en teoretisk grounding ud fra Goldkuhl & Cronholms Multi-Grounded Theory. De eksisterende teorier vi har anvendt dækker over modeller, kognitiv psykologi, interaktions design og informations arkitektur og –design. Resultatet er et sæt guidelines omhandlende bl.a. én fælles adgang til de anvendte systemer inklusiv overføring af patientkonteks mellem systemerne og anbefalinger i forhold til design af brugergrænsefladen. Yderligere skal det være muligt at kunne lave personlige visninger på brugergrænsefladen, i forhold til den enkelte brugers job rolle, færdigheder og den kliniske situation brugeren står i. Derfor bør man i langt højre grad tænke på udvikling af EPJ i et problemløsnende perspektiv frem for kun at kigge på den traditionelle teknologiske tilgang hvor målsætningen er at implementere teknologien. Ved at kigge nærmere på selve informationsdesignet af en EPJ i relation til hvordan værktøjet skal anvendes og understøtte klinikerne vil man kunne nærme sig den nationale målsætning.

Introduction As a consequence of the introduction of the Electronic Patient Record (EPR) in Denmark it has become increasingly difficult for the clinical staff to form an overview of a particular patient history from the electronic media. According to other empirical studies, this phenomenon has been observable outside Denmark as well. One of the main objectives behind the development and implementation of the EPR is to support the work of the clinical staff. This objective has unfortunately not yet been reached. The purpose of this project is to study what kind of information is needed by the clinical staff and what aspects have to be taken into account in forming an overview. The result is a set of guidelines based on the empirical data and the theories of cognitive models, information architecture and –design so as to support the clinical staff in forming an overview of their patient history. Methods Our approach to the study is Grounded Theory as basically described by Glaser and Strauss and later developed by several other authors such as Charmaz and Guvå & Hylander. The empirical data were collected from eight semi-structured interviews including nine clinicians representing different occupations. The interviews were carried out in three hospitals each using a different EPR. The analysis was done according to the principles of Grounded Theory. During the conceptualisation of the approx. 1000 statements from the interviews, we used mind mapping to organize the statements. Result The core category in our analysis, “The formation of the clinical overview”, was supported by four processes including the production and presentation of information in the EPR, resulting in the emergence of a grounded theory. The theory was subsequently exposed to a theoretical matching, according to Goldkuhl and Cronholm´s theoretical grounding in Multi-Grounded Theory. The matching was carried out by means of existing theories concerning models, cognitive psychology, interaction design, information architecture and – design. The result was a set of guidelines focusing on the need for an easy access to the systems in use with single-sign on (including transferring information about the context of patients), and recommendations for the design of a graphic user interface that supports the clinical staff's needs for different kinds of information in their attempt to form a clinical overview. Furthermore, the graphic user interface should include an opportunity for the user to personalize his/her views in the EPR according to his/her job, skills and the clinical situation concerned. Discussion More focus is needed on the problem-solving perspective in the development of the EPR instead of the current exclusive focus on the traditional technological approach. By drawing more attention to the creation of an information design that supports the needs and demands of the clinical staff, we can take a giant step towards the objective of implementing the EPR.

A master programme thesis from Aalborg University

Anvendelse af informationsdesign i den elektroniske patientjournal

[The Use of Information Design in the Electronic Patient Record]