I just don't know why it's gone: maintaining informal information use in inpatient care

ABSTRACT

We conducted a field-based study examining informal nursing information. We examined the use of this information before and after the adoption of a CPOE (Computerized Provider Order Entry) system in an inpatient unit of a large teaching hospital. Before CPOE adoption, nurses used paper working documents to detail psycho-social information about patients; after the CPOE adoption, they did not use paper or digital notes as was planned. The paper describes this process and analyses how several interlocked reasons contributed to the loss of this information in written form. We found that a change in physical location, sufficient convenience, visibility of the information, and permanency of information account for some, but not all, of the outcome. As well, we found that computerization of the nursing data led to a shift in the politics of the information itself - the nurses no longer had a cohesive agreement about the kinds of data to enter into the system. The findings address the requirements of healthcare computerization to support both formal and informal work practices, respecting the nature of nursing work and the politics of information inherent in complex medical work.

REFERENCES

• 1: Jakob E. Bardram, “I love the system—I just don't use it!”, Proceedings of the international ACM SIGGROUP conference on Supporting group work: the integration challenge, p.251-260, November 16-19, 1997, Phoenix, Arizona, United States [doi>10.1145/266838.266922]
• 2: Gro Bjerknes , Tone Bratteteig, The memoirs of two survivors: or the evaluation of a computer system for cooperative work, Proceedings of the 1988 ACM conference on Computer-supported cooperative work, p.167-177, September 26-28, 1988, Portland, Oregon, United States [doi>10.1145/62266.62280]
• 3: Steve Blythin , John A. Hughes , Steinar Kristoffersen , Tom Rodden , Mark Rouncefield, Recognising “success” and “failure”: evaluating groupware in a commercial context, Proceedings of the international ACM SIGGROUP conference on Supporting group work: the integration challenge, p.39-46, November 16-19, 1997, Phoenix, Arizona, United States [doi>10.1145/266838.266852]
• 4: Geoffery C. Bowker , Susan Leigh Star, Sorting things out: classification and its consequences, MIT Press, Cambridge, MA, 2000
• 5: Charmaz, K. Good Days, Bad Days: The Self in Chronic Illness and Time. Rutgers Press, 1993.
• 6: Edwards, D. Philosophy of nursing: An introduction. Basingstoke, Palgrave, 2001.
• 7: Hardey, M., Payne, S., and Coleman, P. 'Scraps': hidden nursing information and its influence on the delivery of care. Journal of Advanced Nursing, 32, 1 (2000), 208--214.
• 8: Gillian Hardstone , Mark Hartswood , Rob Procter , Roger Slack , Alex Voss , Gwyneth Rees, Supporting informality: team working and integrated care records, Proceedings of the 2004 ACM conference on Computer supported cooperative work, November 06-10, 2004, Chicago, Illinois, USA [doi>10.1145/1031607.1031632]
• 9: Christian Heath , Paul Luff, Documents and professional practice: “bad” organisational reasons for “good” clinical records, Proceedings of the 1996 ACM conference on Computer supported cooperative work, p.354-363, November 16-20, 1996, Boston, Massachusetts, United States [doi>10.1145/240080.240342]
• 10: Hyde, A., Hyde, A., Treacy, M., Scott, A., Butler, M., Drennan, J., and Irving, K. Modes of rationality in nursing documentation. Nursing Inquiry, 12, 2 (2005), 66--77.
• 11: Kaplan, B. Evaluating informatics applications - some alternative approaches. International Journal of Medical Informatics, 64 (2001), 39--56.
• 12: Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., and Kimmel, S. E. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA, 293, 10 (2005), 1197--1203.
• 13: Miles, M. and Huberman, M. Qualitative Data Analysis. Sage Publications, Inc, 2nd edition, 1994.
• 14: Reddy, M., Pratt, W., Dourish, P., and Shabot, M.M. Sociotechnical Requirements Analysis for Clinical Systems. Methods of Information in Medicine, 42 (2003), 437--444.
• 15: Kjeld Schmidt , Ina Wagner , Marianne Tolar, Permutations of cooperative work practices: a study of two oncology clinics, Proceedings of the 2007 international ACM conference on Supporting group work, November 04-07, 2007, Sanibel Island, Florida, USA [doi>10.1145/1316624.1316626]
• 16: Susan Leigh Star , Anselm Strauss, Layers of Silence, Arenas of Voice: The Ecology ofVisible and Invisible Work, Computer Supported Cooperative Work, v.8 n.1-2, p.9-30, Feb. 1999 [doi>10.1023/A:1008651105359]
• 17: Strauss, A., Wiener, C. and Shizuko, F. Social Organization of Medical Work. Transaction Publishers, 1985.
• 18: Charlotte Tang , Sheelagh Carpendale, An observational study on information flow during nurses' shift change, Proceedings of the SIGCHI conference on Human factors in computing systems, April 28-May 03, 2007, San Jose, California, USA [doi>10.1145/1240624.1240661]
• 19: Hilda Tellioğlu , Ina Wagner, Work Practices Surrounding PACS: The Politics of Space in Hospitals, Computer Supported Cooperative Work, v.10 n.2, p.163-188, January 15, 2001 [doi>10.1023/A:1011298824442]
• 20: Wagner, I. Women's voice: The case of nursing information systems. AI&Society, 7, 4 (1993), 295--310.
• 21: Yan Xiao, Artifacts and collaborative work in healthcare: methodological, theoretical, and technological implications of the tangible, Journal of Biomedical Informatics, v.38 n.1, p.26-33, February 2005 [doi>10.1016/j.jbi.2004.11.004]

INDEX TERMS

Primary Classification:
  H. Information Systems
  H.0 GENERAL

Additional Classification:
  K. Computing Milieux
  K.4 COMPUTERS AND SOCIETY
      K.4.3 Organizational Impacts
          Subjects: Computer-supported collaborative work

General Terms:
Design, Documentation, Human Factors, Management

Keywords:
cpoe, cscw, electronic patient records, informal information, medical informatics, medical records, organizational memory, psychosocial information, shift change