Negative Impact of Computerized Record Keeping in a Psychiatric Department^*

Abstract

A general hospital psychiatric inpatient department which had been regarded as efficient and effective in its functioning, underwent rapid deterioration after the introduction of a computerized system of charting and record keeping. The deterioration was attributed to: 1) Impeded communication among the staff; 2) Loss of time available for patient care; 3) Staff frustration with the system and subsequent feelings of anger and helplessness being communicated to the patients. The authors describe the development of this deterioration and discuss possible psychodynamic factors and suggested corrective-preventative measures.

Nurses' attitudes towards computerization in clinical practice

“…In respect to category C (general budget of the hospital), the overwhelming majonty of nurses (616%) were of the opinion that the general budget of the hospital increased due to computenzation This result was similar to that of a study conducted by Simpson et al (1982), who showed that the overall impact of computerization on the general budget of the hospital seems to be mcreased The findings of the present study are also inconsistent with the view of Ball & Hannah (1984) They proposed that automation causes a reduction m the cost of health care Concerning category D, the majonty of nurses m the present study (618%) opposed the view that patient care is improved In companson, Thies (1975) and Ball & Hannah (1984) suggest that patient care is improved with the introduction of computers However, the findmgs of the present study are in line with those of McLean & Kapkin (1983)…”

“…In relation to category B (time spent and the ef&aency of nurses), it was found that 61 5% of nurses opposed the idea that more time is available due to automation and that efi&aency of the nurses increased These findings are also in line with those of McLean & Kapkin (1983) They found the detenoration in a general hospital psychiatnc ln-patient department, after the introduction of a computer system, impeded communication among the staff along with vanous other factors In contrast to the findings in the present study, Tolbert & Pertuz (1977) demonstrated that the computer IS a valuable tool to serve as a partial substitute for nurses, and that it will reduce time spent by the nurse in patient care. Ball & Hannah (1984) are also m favour of the view that computers condense the data and save tune, enabling nurses to devote more time to patient care However, the benefits achieved by the time saved through computer-use have not been recognized by the majonty of nurses tabng part in this study…”

Computer generated prescriptions as an audit tool

“…Substance abuse is an area where data collection is often diffi cult and the pressures of the clinical load may cause data collection to take second place. The need for information systems should not be allowed to impose an extra load on clinical staff or the effects of intro duction can have severe negative consequences on units (McLean & Kaplan, 1983).…”