New Publication: Why Hospitals Fail at Improving the Usability of Health Information Technology

We have known for a long time that the usability of health information technology – IT systems used in healthcare organizations for clinical or administrative purposes – leaves a lot to be desired. This is especially true as far as nurses – the largest user group of IT in healthcare – are concerned. Why is that so? There are two main actors shaping the usability of health information technology – IT vendors, who develop off-the-shelf systems that they sell to healthcare organizations, and these healthcare organizations themselves, who commonly have some room to configure and customize the off-the shelves systems they buy from IT vendors. However, researchers have so far focused much more on IT vendors than on healthcare organizations when investigating the causes of health information technology’s lack of usability. My supervisor Åsa Cajander and I therefore decided to try and shed some light on healthcare organizations’ IT department workers’ perspective on nurses’ involvement throughout the development, deployment and maintenance processes of health information technology.

In the context of our project DISA – dedicated to investigating the effects of digitalization on nurses’ work environment – we wrote a thesis proposal for which two students showed an interest. These two students, Deman Hussein and Ali Azeez, interviewed altogether 15 IT department workers, all involved in the configuration, customization and/or maintenance of some of the biggest IT systems in use at the Uppsala University Hospital. Based on the data they collected, we have now published a paper presenting identified breakdowns in the communication channels between nurses and IT department workers. The paper, titled “Communication Breakdowns between Nurses and IT Department: Why Hospitals Fail at Improving the Usability of Health Information Technology”, was presented at the International Symposium on Health Information Management Research (ISHIMR) on September 17. It will made available – along with the other proceedings from the conference – on Linnaeus University’s open access platform shortly. The full text should also soon become available via our DiVA platform.

In the meantime, let me share with you some of the main takeaways from the study. We identified five different communication channels between IT department workers and nurses, two allowing one-way communication from nurses to IT department (error reporting system and meetings with nurse representatives), two allowing one-way communication from IT department to nurses (nurse managers and intranet) and one allowing for synchronous, two-way communication between these two groups (instructor-led training workshops). In addition to the high-level issue of lack of time, which affected both IT department workers and nurses and thus all communication channels, we identified three main breakdowns across the identified communication channels: low quality and low filtering of error reports (error reporting system), non-attendance of nurses (instructor-led training workshops) and misalignment between nurse managers’ and IT department workers’ priorities (nurse managers).

Indeed, IT department workers first indicated struggling to understand nurses’ error reports. This suggests that there is a lack of shared language between IT department workers and nurses, which hinders their attempts at communicating and understanding each other. In addition, IT department workers did not receive all the error reports filled in by nurses, as some of them were filtered out by care coordinators before reaching them. This means that IT department works cannot see the full picture of nurses’ issues with their systems.

Second, our participants lamented that nurses did not show up at the instructor-led training workshops they offered. They saw these workshops as particularly important because they enable them to both explain to nurses how they best use a system and gather feedback from them. Nurses’ not showing up was attributed by our participants to a third issue: nurse managers’ not sending their nurses to training.

The IT department workers included in our study felt that nurse managers were not prioritizing IT-related questions as high as they should, although they also have some understanding for this misalignment between their respective priorities, as they acknowledged that nurses were working in very demanding conditions.

What can then be done in order to improve the communication between IT department and nurses, and thus to increase nurses’ involvement in the development, deployment and maintenance of health information technology? Here are a few suggestions:

  • Having ALL system error reports transferred to the IT department
  • Teaching nurses how to talk about system-related issues (and not only how to interact with the systems)
  • Making room in nurses’ schedules for error reporting and attending training
  • Making room in IT department workers’ schedules for gathering and analyzing nurses’ feedback

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