Abstract

Background & purpose

A pilot-project implementing a fully functional clinical process EPR, configured and used at a neurological ward (acute apoplexy), replacing all paper records 24/7 throughout one week.

• Which parts of an EPR can be standard configured and initially form a stable standard solution to be used by all clinicians?
• Which parts of an EPR can we predict are subject to initial as well as on-going re-configuration in order to meet the needs from diverse medical specialties?

Methods

The analysis characterizes the different types of screens, a total of 243 included in the EPR solution. All screens have been extracted from the application and analyzed for changes – in total 222 changes. The analysis was based on the vendor’s systematic documentation of changes.

All screens were categorized according to type (forms recording data and views displaying data) as well as primary and secondary user-profession (physician, nurse, therapist, interdisciplinary etc.). All changes were categorized into 3 major groupings: No changes (0); Few and initial changes (1-2); Several and sustained changes (>2).

Result

We have identified a number of interesting patterns with regard to the changes made to the screens representing the overall system configuration.

The majority of screens (87%) were subjected to none or few initial changes. These screens typically had a paper ancestor or represented well known tasks.

Only 32 screens required several and sustained changes indicating screens where sustained re-configuration and experimentation is needed. These 32 screens account for 83% of the total number of changes (184 out of 222). These screens were all supporting coordination of data or tasks. The screens included support for an inter-disciplinary approach to EPR, support for new tasks specific to the medical speciality, and a new registration structure supporting the nursing process.

Conclusion

Our study indicates that EPR screens are either stable or must be subjected to several re-configurations that stabilize after an average of six iterations. We can predict that some parts of this configuration will be reduced over time since they address new but also general ways of working with EPR. Other parts addresses themes related to the specific medical specialty indicating parts not standard to clinicians across medical specialities. There are indications that only few specific screens are necessary per medical speciality, and that they can be efficiently configured through an experimental approach in a clinical everyday work environment.