Understanding radio buttons and nursing documentation. How do the users experience being involved in a participatory IT design process?

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Oplægsholder
Navn: 
Stine Loft Rasmussen
Stilling: 
Konsulent
Firma/organisation: 
Region Hovedstaden - It, medico og telefoni
Øvrige deltagere i projektet/initiativet
Navn: 
Merete Lehmkuhl
Stilling: 
Klinisk oversygeplejerske
Firma/organisation: 
Region Hovedstaden - Frederiksberg Hospital
Navn: 
Connie Hangaard
Stilling: 
Kvalitetskoordinator
Firma/organisation: 
Region Hovedstaden - Herlev Hospital
Navn: 
Karen Marie Lyng
Stilling: 
Sektionsleder Klinisk Information og Data
Firma/organisation: 
Region Hovedstaden - It, medico og telefoni
Hovedbudskaber
Disse tre budskaber kan deltagerne forvente at få med hjem efter at have hørt indlægget.
1: 
A participatory design process has been instrumental in the successful implementation of standardized, highly structured, electronic nursing documentation templates in the Capital Region of Denmark.
2: 
The user representatives who took part in the process point to a clear framework for the user involvement as one of the reasons for this success.
3: 
The connection between the design issues and the nursing practice - established through simulation tests - were according to the user representatives another key factor in the success of the project.

In the past years, the Capital Region of Denmark has worked on designing highly structured nursing documentation within the existing electronic health record (EHR). This work has been challenged by lack of regional consensus on the clinical content and documentation procedures, as well as an IT system that inhibited the development. After adjusting the IT system, the organizational challenges where addressed by involving users and stakeholders at many levels of the organization. The end result is a set of electronic templates, which support a large part of the nursing documentation. The templates were tested in a two month pilot implementation in Gentofte Hospital, and were subsequently evaluated jointly by the IMT and the Capital Region's unit of patient-perceived quality. The evaluation concluded that the end users were positive towards the templates and recommended implementation of the templates at all hospitals in the region.

During the design process a number of tools, such as document analysis, site visits, workshops and simulations, were used. As it was important to secure ownership among the broad range of stakeholders involved in nursing documentation and IT system design, all activities in the process were carried out in collaboration with users and stakeholders from various organizational levels. Concurrently, the responsibility regarding the documentation was clarified by the establishment of a regional patient record committee in charge the overall clinical content in the EHR. Furthermore, a set of design principles were developed to serve as a reference for the design of the user interface.

Members of the clinical working group, who participated throughout the process, report that the process assisted in bridging the gap between clinicians, quality officers and IT staff. Through workshops and site visits, the IT staff gained an understanding of the nurses' work practices. At the same time, the nurses participated in workshops and simulation tests, and thereby gained an increased understanding of the IT system as well as a more thorough understanding of the knowledge level regarding clinical issues among the IT staff. According to the nurses, this understanding has enabled them to be creative partners in the design process. As an additional benefit, the nurses now feel that they are well prepared to take part in the local implementation of the templates at their own hospital. Because of the nurses' familiarity with the templates, they can communicate the decisions made during the design process to end users in their own organization.

Motivation: Sharing of clinical data across organizational units is only possible through the collection of structured data with a high degree of standardization. This in turn necessitates agreement on the clinical content needed to be documented. There are many interests involved in clinical documentation and it can be a challenge to reach an agreement among the various users and stakeholders on the level of standardization across clinical specializations, wards, hospitals etc. Participatory design methods emphasize the importance of reaching a shared understanding of the clinical domain and the technical possibilities. This involves not only IT design, but also organizational development and maturing.

The presentation: The presentation will briefly describe the theoretical background of the design process and the execution of the process.  Subsequently, one of the nurses who took part in the process will reflect on selected parts of the process and how these have supported the mutual learning process. The presentation will conclude with recommendations for future similar projects.