As we have advanced in medical informatics and created many impressive innovations, we also have learned that technologic developments are not sufficient to bring the value of computer and information technologies to health care systems. This paper proposes a model for improving how we develop and deploy information technology. The authors focus on trends in people, organizational, and social issues (POI/OSI), which are becoming more complex as both health care institutions and information technologies are changing rapidly. They outline key issues and suggest high-priority research areas. One dimension of the model concerns different organizational levels at which informatics applications are used. The other dimension draws on social science disciplines for their approaches to studying implications of POI/OSI in informatics. By drawing on a wide variety of research approaches and asking questions based in social science disciplines, the authors propose a research agenda for high-priority issues, so that the challenges they see ahead for informatics may be met better.
The benefits for any health care provider of successfully introducing an Electronic Patient Record System (EPRS) into their organisation can be considerable. It has the potential to enhance both clinical care and managerial processes, as well as producing more cost-effective care and care programmes across clinical disciplines and health care sectors. However, realising an EPRS's full potential can be a long and difficult process and should not be entered into lightly. Introducing an EPR System involves major personnel, organisational and technological changes. These changes must be interwoven and symbiotic and must be managed so that they grow together in stages towards a vision created and shared by all clinical professional staff, other staff, and managers in that process. The use of traditional “building” or “journey” metaphors inadequately reflects the complexity, uncertainty and, therefore, the unpredictability of the process. We propose that a more useful metaphor may be of “growing” a progressively more united, unified information system and health care organisation. We suggest this metaphor better recognises that the evolutionary process appears to be more organic than predictable and more systemic than mechanistic. An illustration is given of how these organisational clinical and technical issues might evolve and interweave in a hospital setting through a number of stages.
Considers the problems of a multi‐disciplinary team working together to understand and evaluate a healthcare information system, which itself is situated in a complex organisational and political environment. Provides general discussion of problems faced by evaluators of such systems. Describes this specific evaluation project (Electronic Patient Records in the UK National Health Service), gives an account of the evaluation process as it occurred, highlights some of the problems encountered, and discusses attempts to overcome these. Suggests that social, organisational and political factors are inherent in all such research enterprises, and that in order to facilitate a rich understanding of complex systems, these factors must also be considered as part of the research data.
Abstract:The Health Services Management Unit was established in 1956 and the Centre for Health Informatics in 1988 as one of eight new centres of research and professional practice. New programmes of informatics education have been created to integrate many of the areas of social and management sciences with clinical work. The model, of a multi-disciplinary higher education department based at a University with very substantial departments of Bio-Medicine and Computation, enables the Centre to reflect an alternative paradigm of health informatics. Informatics practitioners from many disciplines are taught a combination of knowledge and skills through a range of educational methods. A classification scheme for educational work is offered.
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