Measuring the operational impact of digitized hospital records: a mixed methods study

摘要

Background Digitized (scanned) medical records have been seen as a means for hospitals to reduce costs and improve access to records. However, clinical usability of digitized records can potentially have negative effects on productivity. Methods Data were collected during follow-up outpatient consultations in two NHS hospitals by non-clinical observers using a work sampling approach in which pre-defined categories of clinician time usage were specified. Quantitative data was analysed using two-way ANOVA models and the Mann-Whitney U test. A focus group was held with clinicians to qualitatively explore their experiences using digitized medical records. The quantitative and qualitative results were synthesized. Results Four hundred six consultations were observed. Using paper records, there was a significant difference in consultation times between hospitals ( p =?0.016) and a significant difference in consultation times between specialties within hospitals ( p =?0.003). Using digitized records there was a significant difference in consultation times between specialties within a hospital ( p =?0.001). Excluding outliers, there was no significant difference between consultation times using digitized records compared with consultations using paper records in the same hospital, either at site ( p >?=0.285) or specialty level ( p >?=0.122). With digitized records at site A, two out of three specialties showed a significant increase in time spent searching computer records ( p Conclusions Digitized medical records can be implemented without detrimental operational impact. Inherent differences between specialties can outweigh the differences between paper and digitized records. Clear and consistent operational processes are vital for the reliability and usability of digitized medical records. Divergent views about usability (such as whether patient summary information is better or worse) may reflect familiarity with features of the digitized record.