HIS-Monitor: an approach to assess the quality of information processing in hospitals.

OBJECTIVES: Hospital information systems (HIS) are a substantial quality and cost factor for hospitals. Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed HIS-Monitor, comprising about 107 questions, focusing on how a hospital information system does efficiently support clinical and administrative tasks. METHODS: The structure of HIS-Monitor consists of a matrix, crossing HIS quality criteria on one axis with a list of process steps within patient care on the other axis. HIS-Monitor was developed based on several pretests and was now tested in a larger feasibility study with 102 participants. RESULTS: HIS-Monitor intends to describe strengths and weaknesses of information processing in a hospital. Results of the feasibility study show that HIS-Monitor was able to highlight certain HIS problems such as insufficiently supported cross-departmental communication, legibility of drug orders and other paper-based documents, and overall time needed for documentation. We discuss feasibility of HIS-Monitor and the reliability and validity of the results. CONCLUSIONS: Further refinement and more formal validation of HIS-Monitor are planned.

HIS-monitor: quality of information processing in hospitals.

Systematic monitoring of HIS quality is an important task; however, this task is often seen to be insufficiently supported. To support systematic HIS monitoring, we developed the HIS-Monitor questionnaire, focusing on how a hospital information system (HIS) does efficiently support clinical and administrative tasks. HIS-Monitor was applied in a feasibility study with 102 nursing participants. Results point to strengths and weaknesses of information processing in the participating departments. Based on the experiences of the feasibility study, HIS-Monitor is now further being optimized.

From a paper-based transmission of discharge summaries to electronic communication in health care regions.

OBJECTIVES: In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record. METHODS: In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care. RESULTS: After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome. DISCUSSION: The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.