H.Laerum, Kvalis

Evaluation of EMR : Modeling the way physicians work

Hallvard Lærum, M.D.Hallvard Lærum, M.D.

Faculty of medicineFaculty of medicine

H.Laerum, Kvalis

What is an EMR?

”A patient record, in which all information is stored electronically in such way that it may be found and reused by means of computer tools”Heimly V, Ree AO, and Yang JJ: "Den elektroniske pasientjournalen - Status og aktuelle områder for felles tiltak"; 1998; 9/97; KITH

Universal Medical Language System (UMLS):

626 893 concepts1 358 891 terms

10 000 m of this

H.Laerum, Kvalis

Why is evaluation difficult?

• Complex computer systems supporting Complex computer systems supporting complex work patterns in complex work patterns in complex organizations complex organizations

• Bias - all sortsBias - all sorts

• The experts don’t doThe experts don’t dowhat they say, what they say, and they don’t sayand they don’t saywhat they dowhat they do

Error??

H.Laerum, Kvalis

Observation vs. other evaluation methods

• Questionnaries lieQuestionnaries lie

• Hard end points are too hardHard end points are too hard

• An expert can’t completely tell you An expert can’t completely tell you how he or she “does it”how he or she “does it”Brender J. Methodology for constructive assessment of IT-based systems in an organisational context. Int.J.Med.Inf. 1999;56:67-86.

Heathfield HA, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ 1998;316:1959-61.

Friedman CP, Wyatt J. Evaluation methods in medical informatics. New York: Springer, 1997, Chap. 1, ”Challenges of Evaluation”; 6-7.

H.Laerum, Kvalis

The data

• Short pilot: 5 physicians, 27 patients, Short pilot: 5 physicians, 27 patients, two wards, 7 h observation timetwo wards, 7 h observation time

• Field notes: 2500 lines of textField notes: 2500 lines of text

H.Laerum, Kvalis

The model

D e finep rob lem

G e t m e d ica lkn o w le d ge

G e t p a tie n td a ta

C re a te n ewin fo rm a tion

In fo rmP a tie n t

N e g otia tew ith p a tie n t

E xecu tein te rve n tion

D o cum e nta c tiv ity

D ia gn o s tics an d Tre a tm e nt

G e t e x is tingp lan

G e t in foa b ou t reso urces

N e g otia tew ith p a tie n t

In fo rmP a tie n t

D o cum e ntp lan

P la nn ing

G e ne ra llo g is tics

C o m m u n ica tion

A d m in is tra tive

R e se a rch

Q u a lityC o n tro l

T e a ch ing

P a tien t's re la tionto soc ie ty

O th er

O th er

H.Laerum, Kvalis

Applications for the model

Self-reporting questionnaries

?

Time studiesSummaries:Tasks

:

Observation time

H.Laerum, Kvalis

Applications for the model II

Information source studies

Computer use studies

H.Laerum, Kvalis

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