Evaluating the impact of implementing clinical information systems

The implementation of clinical information systems across the healthcare community has been declared as a necessary element to improve the quality and access to patient care. As part of that process, it is imperative that researchers evaluate the impact of implementing these systems to ensure that the desired outcomes are being achieved. This dissertation comprises three scholarly projects that specifically explore the issues surrounding the impact of implementing these systems across various healthcare environments. The first project involves the development of a conceptual framework to be used as a tool to guide researchers as they consider how to evaluate the impact of implementing clinical information systems. The framework was developed through literature reviews and feedback from a panel of informatics experts. The final version of the framework encompasses three elements of impact (human, technological, financial) that can be considered at four levels of granularity (individual, institutional, trans-organizational, trans-national). The second project focuses on evaluating the impact of implementing a new pharmacy information system. Qualitative and quantitative techniques were used to evaluate the productivity of pharmacists as they entered medication orders in the old versus the new system. Overall, pharmacists' productivity was the same across the two systems with the exception that they perceived that they were slower entering orders in the new system. The third project is a case study exemplifying the financial impact of replacing a disparate set of pharmacy systems with an enterprise-wide electronic health record. In the post-implementation environment a multidisciplinary team identified problems with the process of applying unit conversions to medications prior to billing submission, which temporarily resulted in significant financial losses. This study provides a real-world example of issues that were encountered and the subsequent steps that were taken to rectify the problems as they were discovered. In summary, all of these projects have been undertaken to further the growth and development of the evaluation processes that are necessary as we strive toward integrated information transfer and improved patient care processes.