Tailor the system or tailor the user? How to make better use of electronic patient record systems

University dissertation from Uppsala universitet

Abstract: Health care organisations are extremely complex because they consist of heterogeneous groups of people (clinical professions, patients, managers), use advanced technology (medical devices and patient record systems), and apply many organisational and clinical routines. When introducing Electronic Patient Record systems (EPR) in health care organisations, all these aspects get affected. Using a sociotechnical perspective is necessary in order to get a "successful" EPR usage.The aim of my PhD studies is to provide health care organisations with knowledge and insights into how they can improve their organisation and practice in relation to usage of EPR systems. In my research I have used a grounded theory methodology for studying, analysing and reflecting on how electronic patient record systems are used by professionals in their practice. Studies have been conducted during a 2.5 years collaborative research project. Within the studied health care organisation there are differing opinions if an EPR system is mainly a technical system or a tool to support the clinical organisation. This conceptual division leads to an uncertainty in who is responsible for the proper function of the EPR system and have a major effect for the clinicians in their clinical practice. During the research seven potential problems areas, mandate, usability, education, participation, improvements, support and evaluation have been identified as crucial for the health care organisation to manage to achieve an effective EPR usage.The main results are 1) The health care organisation needs to establish a problem-solving strategy that questions the reasons behind the problems occurred, 2) The different stakeholder groups need to interact, create a better understanding for each other's perspective and agree on the same goal for the EPR system, 3) The clinical organisation needs help to improve their clinical practice in relation to the EPR system, 4) The EPR deployment and usage affect the clinicians in different ways. Their attitude towards the EPR system is dependent on the usability of the EPR system, the deployment process, their experience of participation, education, support and possibilities to improve the system.