BackgroundThe increased application of eServices in health care, in general, and ePrescribing (electronic prescribing) in particular, have brought quality and interoperability to the forefront. The application of standards has been put forward as one important factor in improving interoperability. However, less focus has been placed on other factors, such as stakeholders’ involvement and the measurement of interoperability. An information system (IS) can be regarded to comprise an instrument for technology-mediated work communication. In this study, interoperability refers to the interoperation in the ePrescribing process, involving people, systems, procedures and organizations. We have focused on the quality of the ePrescription message as one component of the interoperation in the ePrescribing process.ObjectiveThe objective was to analyze how combined efforts in improving interoperability with the introduction of the new national ePrescription format (NEF) have impacted interoperability in the ePrescribing process in Sweden, with the focus on the quality of the ePrescription message.MethodsConsecutive sampling of electronic prescriptions in Sweden before and after the introduction of NEF was undertaken in April 2008 (pre-NEF) and April 2009 (post-NEF). Interoperability problems were identified and classified based on message format specifications and prescription rules.ResultsThe introduction of NEF improved the interoperability of ePrescriptions substantially. In the pre-NEF sample, a total of 98.6% of the prescriptions had errors. In the post-NEF sample, only 0.9% of the prescriptions had errors. The mean number of errors was fewer for the erroneous prescriptions: 4.8 in pre-NEF compared to 1.0 in post-NEF.ConclusionsWe conclude that a systematic comprehensive work on interoperability, covering technical, semantical, professional, judicial and process aspects, involving the stakeholders, resulted in an improved interoperability of ePrescriptions.
InteroperabilityCapability to interoperate in a shared work practice using information infrastructures -studies in ePrescribing Columbo AbstractThe ability to interoperate between systems, people, and organizations is considered an important issue within eHealth in order to deliver patient centered care. The achieving and improving of interoperability is a complex undertaking involving the evolution of an information infrastructure, sharing of knowledge and resources, governance of the interoperation between organizations, people and work practices, and handling of economic and legal matters. However, there is a weak scientific basis for interoperability, and proposed initiatives to improve interoperability largely lacks empirical evidence of their utility.This thesis contributes with practical knowledge on improving interoperability, based on active participation in and empirical studies of improving interoperability in ePrescribing. A case study is presented that describes and analyzes the evolution of ePrescribing in Sweden since the early pioneering years in 1980s, its growth and consolidation before the reregulation of the pharmacy market in 2009. The case study shows the importance of cooperation between the stakeholders for the growth and consolidation of ePrescribing, and identifies important events in the evolution of an advanced information infrastructure. To better understand the complexity of ePrescribing work practice, a practical theory on ePrescribing was developed. A unique field experimental study measuring improvement of interoperability in ePrescribing, before and after a major intervention to improve the quality of ePrescriptions between 2004 and 2009 is presented. The findings from the field experimental study showed that collective efforts to clarify and align the shared ePrescribing work practice and the ePrescription message contributed to substantially improve interoperability in ePrescribing.Based on the findings and knowledge gathered in the situational inquiry into the evolution of ePrescribing in Sweden, the improvement of interoperability, and the application of theories about information systems actability, communication and organizational theories, a practical theory on interoperation and interoperability aiming both towards the practice and research community is presented. Interoperability is seen as the exercised capability of organizations through their agents to interoperate in a shared work practice in an effective, efficient, and satisfactory manner based on a common ground in a mediated, prescriptive, and nonpersonal communicative setting using an information infrastructure for mediating interoperation. The plausibility that the theory of interoperation and interoperability grounded in ePrescribing is generalizable to eHealth is analyzed. ForewordInformation Systems Development (ISD) is a research discipline within the Faculty of Arts and Sciences at Linköping University (LiU), Linköping Sweden. ISD is a discipline studying human work with developing and changing different...
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