paper: user-designed information tools

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User-designed information tools to supportcommunication and care coordination in a trauma hospital

Gurses et al. J Biomed Inform. 2009 Aug;42(4):667-77

does not evaluate an electronic information tool or system

offers insight on how clinicians manage info in spite of tools to

make their job easier

Why This Paper?

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

information technology introduced into many sectors = efficiency, quality

some advances in health care related to admin IT systems, not clinical ITsystems

Why This Paper?

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

qualitative methods provide a glimpse of what is ideal v. what is actually done in practice

provide information for designing systems

What Makes It Interesting?

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Ayse P. GursesJohns Hopkins, School of Medicine

junior researcher (2005)

body of work centres on qualitative methods, interviews, observations

clinical settings, nurses, information

The Authors

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Yan XiaoUniversity of Maryland, School of Medicine

engineer – human factors

body of work centres on qualitative methods, observations

clinical settings, information

The Authors

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

information technology professionals health administrators health decision-makers

Who Should Be Interested?

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

clinicians create their own tools understanding why tools are built

allows for development of systems to meet clinicians’ needs

Background

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

To describe the design characteristics and use of a clinician-designed information tool in supporting information transfer and care coordination

Objective

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

The researchers used: shadowing photographs interviews clipboardsto qualitatively examine the use of a clinician-designed information tool that was meant to support information transfer and care coordination

Methods

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Trauma care hospital

Setting

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

A – EMR

B - Access

C - Census

D – Attending

E - Team

F – Nurses

G – Nurse Assts

H - Float

I – Beds

J,K – Next Shift

Analysis of shadowing, interviews, photographs, and samples of the

clipboards

Outcome Measures

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Nurse coordinators use a paper-based information tool designed internally that compiled essential data from

disparate information sources

Results

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Information tools will be designed by users to meet their needs

Conclusions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

The characteristics of these tools and systems provide valuable insight into the needs of the users in relation to

information health technologies

Conclusions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

There is a role for users in helping to design their own information

systems

Conclusions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Equator Network

1. COREQ – interviews and focus groups (2007)

2. Evolving Guidelines – psychology and related fields (1999)

Assessment

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Essential:

1 nurse coordinator not interviewed

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Essential:

data saturation not discussed

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Essential:

limited information about interviews: length, audio-taping,

field notes, etc.

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Essential:

no declaration of a paradigm framework or philosophic

assumption

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Essential:

mixing of analytic approaches: ethnographic methods,

grounded theory

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Helpful:

full interview guide offered online

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Helpful:

member checks

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Less Essential:

software not mentioned (perhaps it was not used?)

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

Less Essential:

more narrative

Limitations

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

pre-test used with observation instrument

shadowing described more thoroughly than other activities

triangulation

Done Well

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

interview with 1 nurse coordinator

paradigm framework

mixing of analytic approaches

more info about interviews, other activities

Questions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

interview with 1 nurse coordinator

paradigm framework

mixing of analytic approaches

more info about interviews, other activities

Questions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

interview with 1 nurse coordinator

paradigm framework

mixing of analytic approaches

more info about interviews, other activities

Questions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

interview with 1 nurse coordinator

paradigm framework

mixing of analytic approaches

more info about interviews, other activities

Questions

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

the Clipboard is used more often than other information sources available

essential factors are portability, rapid accessibility, customizable, easy to add or change information

Implications

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

these features out-weight accuracy

Implications

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

need for adaptable, flexible systems

no concrete beginning point or end point in creating systems

accept a hybrid system, ‘paperless’ may not be possible

Implications

Material in support of a verbal presentation, not for interpretation as a stand-alone document09 November 2009

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