Studying EPRs in hospitals

1. Studying EPRs in hospitals Gunnar Ellingsen University of Tromsø NSEP Doing research on EPRs in hospitals

2. My background • Researcher at the University of Tromsø • Ph.D. from IDI-NTNU on EPR systems in hospitals • IT-consultant at the University hospital of North Norway Doing research on EPRs in hospitals

3. Structure of the presentation • Interpretive IS research • The role of the patient record in hospitals • The Norwegian health care sector and expectations to EPRs • Brief overview on EPR systems • How a changing health care sector shape the EPR Doing research on EPRs in hospitals

4. Interpretive IS research • Cannot see IT in isolation • Context, interaction, interpretation • No given ‘truth’ • No neutral IS • The data collection (ethnography) • Participant observation • Interviews • Video • University hospital North Norway Doing research on EPRs in hospitals

5. Becoming an insider “In here you will be taken for a physician if you wear that white coat” (Physiotherapist in the Dept. of Rehabilitation) Doing research on EPRs in hospitals

6. The role of the patient record in hospitals • A working tools for health personnel • Organisational memory • Communication and coordination • Education and research • Collaboration between professional Doing research on EPRs in hospitals

7. Characteristics of the paper-based record • Clear boundaries: what is there is all there is • The thickness of the paper record • The leaf effect • Top-down versus bottom-up • Mobility • Structured organisation of the content Doing research on EPRs in hospitals

8. The structure: a threat to collaboration? Doing research on EPRs in hospitals

9. Challenges when starting to useEPRs • Maintaining the comprehension that there should be clear boundaries to the environment • Enforcing the division of labour • Formalising the writing process • Making the EPR a tool for health personnel when patients are hospitalised • The curve book • Overview versus searching for specific information Doing research on EPRs in hospitals

10. Diving into the problems of the Norwegian health care sector • An expensive sector • 55 billions budget for the Regional health enterprises • 45 billion spent through the municipalities • From treatment to prevention • The population is getting older Doing research on EPRs in hospitals

11. Information flow Doing research on EPRs in hospitals

12. How is the EPR instrumental in change - Governmental action plans • More health for each bIT (1997-2000) • The EPRs as a means for “freeing time for the health care workers” • Electronic Interaction in the Health and Social Sector (2001-2003) • Change work processes • Ensure quality improvement and coordinate treatment of patients. • Interplay 2007: Electronic cooperation in the health and social sector (2004-2007) • Improve process flow Doing research on EPRs in hospitals

13. Three hospital-based EPR systems Doing research on EPRs in hospitals

14. Complex organisations Complexity of making EPRs University hospitals Middle-sized hospitals Primary care Size of health institution Doing research on EPRs in hospitals

15. The failure of the monolith: The Medakis project at its closure • Seven years of development • Terminated in 2003 • A failure when compared to the goals • Replacement of paper • Dissatisfaction: functionality, integration, user-participation • Local problems, global strategies Doing research on EPRs in hospitals