An Evaluation of Mobile Computing effect on Oncologists Workflow in Ambulatory Care Settings.

摘要

Rationale: The Cancer Agency Information System (CAIS) is the primary patient record for the British Columbia Cancer Agency (BCCA) but is only accessible on fixed computer workstations. The BCCA clinics have significant space limitations resulting in multiple healthcare providers sharing each workstation. Furthermore, workstations are not available in the patient examination rooms leading to multiple visit interruptions. Given that timely and efficient access to patient electronic records is fundamental in providing optimal patient care, the iPad Mobility Project was launched to introduce and evaluate the effect of mobile technologies and applications in improving access to CAIS and supporting clinicians' workflow.;Methods: The project evaluation framework was created in collaboration with the project stakeholders including BCCA clinicians. The framework included pre- and post-implementation questionnaires, pre- and post-implementation observational sessions, and post-implementation semi-structured interviews. Survey questionnaires mainly included standardized scales used to measure user expectations and perceptions before and after information systems implementation. Also, based on Canada Infoway System and Use Survey, the post-implementation questionnaire included questions that measure the mobile system success in terms of information quality, system quality, service quality, user satisfaction, and use measures. The response rate was 84% (n=44) for the baseline survey and 76% (n=52) for the post-implementation survey. Also, baseline and post-implementation observational sessions (n=5, n=6 respectively) were conducted to provide real-time data about the use of the available record keeping systems before and after the mobile system implementation. Post-implementation semi-structured interviews (n=11) were conducted to allow clinicians to reflect on their use of the iPad and VitalHub Chart application.;Results: The results showed an overwhelmingly positive attitude to the use of the iPad and the VitalHub Chart application to support clinicians' mobile workflow through enhanced access to CAIS. Perceived benefits were related to three major categories: information accessibility and inter-professional communication; workflow efficiency and provider productivity, and patient care quality and safety. Conversely, perceived challenges were related to three major categories: software related challenges, hardware related challenges, and network infrastructure-related issues. Furthermore, the results showed that the success of mobile computing technology depends on its ability to support access to patients' electronic records and other central clinical information systems, on mobile devices and their applications' ergonomic features, and on end-user participation in mobile computing projects.;Implications: Mobile computing technologies have the potential to improve data accessibility, communication mechanisms, patient care quality, and workflow efficiency. However, realizing the full potential benefits of mobile computing technologies rely on several factors. Healthcare organizations need to have clear understanding of end users' needs, expectations, clinical tasks, and workflow. Engaging end-users in mobile computing technologies projects from the early stages of the project is essential to identify the various complex human, organizational, and contextual factors that affect the success of enterprise-wide mobile computing technology projects. Due to their inherent limitations, mobile computing technologies should be considered as complementary to and not as replacement to fixed computer workstations. Also, evaluating mobile technologies and applications usability is essential for both the success and safety of such innovative solutions.