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STRATEGY, IMPLEMENTATION AND EVALUATION 213 any kind of comparative study with similar non-EPR sites, as each site is unique and the resources available for the evaluation were insufficient to cover the additional control sites. The project team responsible for the PDMS implementation made a questionnaire for nurses and doctors. This questionnaire was based on a validated questionnaire that was, however, not aimed at information technology, but at a totally different topic. As a consequence, the questions of the original questionnaire had to be rephrased, some questions were left out and some new questions were added. This new questionnaire was seen as suitable for the PDMS context. For the evaluation of the technical success of the implementation, a practical study design was found: the functional demands (which were found in an initiation document) were compared to the PDMS-in-use. Issues ■ ■ ■ Stakeholders often assume that a (randomized) controlled trial is the only way of evaluating a system. There is a lack of understanding about how to match study designs and evaluation questions. Stakeholders underestimate the skills and time needed to design questionnaires and conduct interviews and focus groups. Challenges ■ ■ Ensure that the evaluation resources are appropriate to the size and type of project. Convince the project and steering group that a pragmatic research design is the most optimal research design for formative evaluation projects. Step 5 Analyse and report The interpretation of the data can be complicated. Even when one has a very clear and limited research question, the effects of the implementation of applications can be diverse and unexpected. Several elements (such as the culture of a hospital regarding innovation, the computer literacy of professionals, work satisfaction or the way professionals work together) can impact the implementation, and should therefore be included in the evaluation. Yet even when this is done, it often remains a difficult task to ascribe the impact of the different elements to the outcomes measured. Second, though from the data it may appear that the system has no impact, this does not mean that this is the case. For example, results may be contradictory or
214 EVALUATION OF PCISS unclear which makes it impossible to draw valid conclusions. It may also be that though the parameters used in the evaluation do not show any impact, professionals or patients do perceive a difference (on parameters not measured). Third, the object of evaluation often steadily changes. Because of staff or workflow changes, software modification, training sessions, etc., the information system may change and be in the end markedly different from what it was at the beginning of the study. In addition, for many applications it is generally difficult to make statements about the success or failure of a system immediately after the implementation phase, because it often takes years for systems to have its maximum impact. It takes time for work processes to find an optimal equilibrium with the new system, for conceptual, design and implementation errors to be repaired, and so forth. This is called the ‘evaluation paradox’: although it is desirable to get evaluation results as soon as possible so that one can decide on following steps (e.g. adjustments or aborting the system), it is often impossible to generate ‘final’ results within short time. CASE STUDY The EPR case study illustrated the problem of not presenting results as accessible for the client or the commission. Instead of a clear and practical guidance in the form of recommendations, a large report was delivered with different kinds of results—ranging from mainly descriptive material about the way health care professionals work (many hundreds of pages!) to short technical reviews, e.g. on the robustness of the system. As we already said, the results were impossible to triangulate. Subsequently, it was left to the client to search through and identify the salient points (which of course was unrealistic). Furthermore, the report was delivered after major decisions about future EPR initiatives were made. The results of the PDMS case illustrated the differences in perception of success of the system between and even within groups of stakeholders, for example regarding time investment in the system. Though the system made several manual activities superfluous (like making and checking the 24 hours-list, or copying the medication list and the nursing orders list to every new bed chart), these activities were normally conducted during the nightshift and the gained time remained therefore unnoticed for the dayshift. Also, because of readability and automatic storage of prescriptions, the use of the PDMS on one location (the ICU ward) saved time on another (the pharmacy connected to the ICU ward). Bringing such issues to light is often crucial to prevent mutual frustrations to fester.
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Health Information Management In al
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Health Information Management Integ
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Contents List of illustrations vii
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Illustrations FIGURES 3.1 Medicatio
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Contributors Marc Berg is a physici
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Series preface In almost all Wester
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Acknowledgements I would like to th
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Chapter 1 Introduction In all Weste
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INTRODUCTION 3 touch upon the deplo
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INTRODUCTION 5 can draw upon to mai
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INTRODUCTION 7 Physician Order Entr
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Part I Starting points Understandin
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WAITING FOR GODOT 11 KEY TERMS ■
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WAITING FOR GODOT 13 Netherlands an
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WAITING FOR GODOT 15 facts to show
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WAITING FOR GODOT 17 (Lewinski-Corw
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WAITING FOR GODOT 19 In most cases,
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WAITING FOR GODOT 21 (Anonymous 191
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WAITING FOR GODOT 23 Because of the
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WAITING FOR GODOT 25 they simply sa
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WAITING FOR GODOT 27 expected. Stil
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WAITING FOR GODOT 29 organize their
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WAITING FOR GODOT 31 performance in
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WAITING FOR GODOT 33 different HIS
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WAITING FOR GODOT 35 CONCLUSION: TH
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WAITING FOR GODOT 37 assumption tha
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WAITING FOR GODOT 39 Anonymous (191
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WAITING FOR GODOT 41 Berg, M. (1997
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Chapter 3 Health care work and pati
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HEALTH CARE WORK AND INFORMATION SY
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THE CONTEXTUAL NATURE OF INFORMATIO
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Chapter 5 Meeting the challenge Int
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STARTING POINTS 81 ‘gender, race,
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STARTING POINTS 83 Now, imagine an
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STARTING POINTS 85 organization,
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STARTING POINTS 87 Figure 5.2 Incre
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STARTING POINTS 89 already overflow
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STARTING POINTS 91 responsibilities
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STARTING POINTS 93 answer the quest
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STARTING POINTS 95 Kohn, L.T., J.M.
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Chapter 6 Designing interactions En
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DESIGNING INTERACTIONS 99 the way t
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DESIGNING INTERACTIONS 101 1 Identi
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DESIGNING INTERACTIONS 103 the deve
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DESIGNING INTERACTIONS 105 communic
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DESIGNING INTERACTIONS 107 Figure 6
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DESIGNING INTERACTIONS 109 ■ Figu
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DESIGNING INTERACTIONS 111 measurem
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DESIGNING INTERACTIONS 117 Covell D
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Part II Information strategy, imple
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INFORMATION STRATEGY: AN INTRODUCTI
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Chapter 8 Developing the informatio
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STRATEGY, IMPLEMENTATION AND EVALUA
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Guidelines for information system d
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Page 178 and 179: STRATEGY, IMPLEMENTATION AND EVALUA
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