Testing technology in the ‘real world’ of acute healthcare: making it work. Presented by Bernice Redley, Deakin University, Australia, at HINZ 2014, 12 November 2014, 12.22pm, Plenary Room

1. Testing technology in the
‘Real world’ of acute
healthcare: making it work
Presenter: Assoc. Prof. Bernice Redley1
M. Botti1, J. Considine2, K. Coleman1, I. Mohammad3, P. Haddad1, H. Moghimi3, N.
Wickramasinghe3
1 Epworth/Deakin Centre for Clinical Nursing Research
2 Eastern Health - Deakin University Nursing and Midwifery Research Centre
3 Epworth Healthcare and RMIT University Health Information Management Department
HINZ Conference November 2014

2. THE PROBLEM (1)
Features of nursing work predispose safety risks
• Repetitive, responsive, high cognitive load
• Frequent tasks, task-switching, multi-tasking
• Interruptions, distractions
• Waste, missed care
Nurses often overwhelmed by documentation1
Design deficiencies in nurse documentation contribute
to communication failures in multidisciplinary team2-4

3. THE PROBLEM (2)
Poor adoption of contemporary IT systems5-8
• Complex, repetition and waste
• Nested and hierarchical data structures are complicated
• Siloed systems: multiple passwords, limited data access
• Fit with daily workflows and processes of nursing care
• Workarounds compromise integrity
• Unintended consequences impact patient safety
Usability a source of clinician work dissatisfaction9,10
92% nurses dissatisfied with EHR11

4. SYSTEM OBJECTIVES
Design priorities of the system
• Free up nurses’ time for patient care;
• Create a better record of patient care; and
• Provide a positive enhancement to nurses’
work experience

5. THE RESEARCH PROGRAM
Collaboration of Aust. SME, University and Health services
Program of research commenced in 2011:
• 2011-Test concept prototype with expected end users
• 2012-Test prototype in with end users in simulated clinical environment
• 2013-Test prototype with nurses in ‘real’ clinical settings
• 2014 (in progress) –Needs of with multidisciplinary users
Multi-stage iterative development research involved end users in
development and design to examine
• Acceptability
• Usability
• Fidelity

6. THE SOLUTION
Point of care technology:
• Located at the patient’s
bedside in acute hospital
wards
• Central nurse station unit
with slightly different
functionality
• Replaces the current paper
nursing documentation

7. THE SOLUTION
Support quality and safety of
nursing care processes
– nursing specific information
– document patient care, review
patient care information
– plan care, communicate changes
in care delivery
– easily accessible, real time,
legible
– available to all members of the
multidisciplinary health care
team-pilot focuss on nurses

8. DESIGN STRATEGY
Design considered multiple theories
• Actor Network Theory (ANT) 12,13: user interactions
• User centred design (UCD)14,15 &Design science
research (DSR)16,17: user input to improve functional
performance
• Nursing processes18: fit with nursing tasks, activities
and workflow
• UTAUT19:acceptance and usability of technology
Informed by the Australian Quality and Safety
Framework for Health Care20

9. KEY LEARNINGS
Consider multi-methods & multi-perspectives
User engagement at all stages
• Understand the perceptions of end-users
• Proactively address concerns: both real and perceived
• Identify important points of leverage for engagement
• Promote ownership of process and product
• Manage expectations of developers and end-users
Incremental design
• Learnings at each stage enhance the next
• Responsive to user feedback

10. KEY LEARNINGS
Significant enhancements to system safety and
usability facilitated by:
• Safe testing in simulation AND ‘real’ environments
• Understand unintended consequences and safety
risks as they emerge
• Identify and mitigate potential risks
• Fidelity to workflow, processes and tasks
• Maintain focus on greatest potential for benefit
• Enhance positive work practices

11. TAKE HOME MESSAGES
IT in health very complex- need
multiple perspectives
Structured involvement of end-users
at all stages; manage expectations
Iterative development & design
responsive to findings: constant
evolution
Collaborative research and
development

12. ACKNOWLEDGEMENTS
Research Team
Leaders, champions and data collectors at
participating sites
• Hospital and Nursing Executives
• IT and engineering departments
• Managers
• Ward Nurses
• Patients
Funded by SmartWard

13. Thank you
Bernice.Redley@deakin.edu.au

14. REFERENCES
1. Cunningham, L., et al., Patients Not Paperwork– Bureaucracy affecting nurses in the NHS. 2012, NHS Institute for Innovation and Improvement.
2. Braaf, S., E. Manias, and R. Riley, The role of documents and documentation in communication failure across the perioperative pathway. A literature
review. Int J Nurs Stud, 2011. 48(8): p. 1024-38.
3. Keenan, G., et al., Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information. J Am Med Inform Assoc, 2013.
20(2): p. 245-51.
4. Jefferies, D., M. Johnson, and D. Nicholls, Nursing documentation: how meaning is obscured by fragmentary language. Nurs Outlook, 2011. 59(6): p. e6-
e12.
5. Stevenson, J.E., et al., Nurses' experience of using electronic patient records in everyday practice in acute/inpatient ward settings: A literature review.
Health Informatics J, 2010. 16(1): p. 63-72
6. Darbyshire, P., 'Rage against the machine?': nurses' and midwives' experiences of using Computerized Patient Information Systems for clinical
information. J Clin Nurs, 2004. 13(1): p. 17-25.
7. Ballard, E.C., Improving information management in ward nurses' practice. Nurs Stand, 2006. 20(50): p. 43-8.
8. Lau, F., et al., A review on systematic reviews of health information system studies. J Am Med Inform Assoc, 2010. 17(6): p. 637-45.
9. Friedberg, M.W., et al., Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.
2013, RAND Corportation & American Medical Association.
10. Murphy, K., EHR Usability Cause of Key Pain Points for Healthcare CIOs, in EHR Intelligence Newsletter. 2014, Xtelligent Media.
11. Perna, G., Nurses Dissatisfied with EHRs, Report Finds. 2014, Healthcare Informatics (Available at http://www.healthcare-informatics.com/news-item/
nurses-dissatisfied-ehrs-report-finds?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+healthcare-informatics+(
Healthcare+Informatics)
12. Latour, B., (2005). Reassembling the social: an introduction to Actor-Network Theory Oxford University Press, Oxford
13. Cresswell, K.M., Worth, A. & Sheikh, A., (2010). Actor-Network Theory and its role in understanding the implementation of information technology
developments in healthcare. BMC Medical Informatics and Decision Making, 10, p.67
14. Norman, D. and S. Draper, User Centered System Desig. New Perspectives on Human-Computer Interaction. 1986, London: Lawrence Erlbaum Associates.
15. Abras, C., D. Maloney-Krichmar, and J. Preece, User-Centered Design, in Encyclopedia of Human-Computer Interaction, W. Bainbridge, Editor. 2004,
Thousand Oaks Sage Publications
16. Hart, D. and S. Gregor, eds. The Role of Design Science. 2010, ANU E Press: The Australian National University, Canberra.
17. Hevner, A. and S. Chatterjee, Design Research in Information Systems: Theory and Practice. 1st ed. Integrated Series in Information Systems2010:
Springer.
18. Meleis, A. 2011. Theoretical Nursing: Development and Progress (5th ed). Wolters Kluwers Health Lippincott Williams & Wilkins. Philadelphia.
19. Venkatesh, V., Morris, M.G., Davis, F.D., and Davis, G.B. “User Acceptance of Information Technology: Toward a Unified View,” MIS Quarterly, 27, 2003,
425-478.