Westbrook Johanna I, Coiera Enrico W, Sophie Gosling A, Braithwaite Jeffrey
Centre for Health Informatics, Cliffbrook Campus, University of New South Wales, Kensington, Australia.
Int J Med Inform. 2007 Feb-Mar;76(2-3):234-45. doi: 10.1016/j.ijmedinf.2006.03.006. Epub 2006 Jun 22.
Online evidence retrieval systems are a potential tool in supporting evidence-based practice. Effective and tested techniques for assessing the impact of these systems on care delivery and patient outcomes are limited.
In this study we applied the critical incident (CI) and journey mapping (JM) techniques to assess the integration of an online evidence system into everyday clinical practice and its impact on decision making and patient care. To elicit incidents semi-structured interviews were conducted with 29 clinicians (13 hospital physician specialists, 16 clinical nurse consultants (CNCs)) who were experienced users of the online evidence system. Clinicians were also asked questions about how they had first used the system and how their use and experiences had changed over time. These narrative accounts were then mapped and scored using the journey mapping technique.
Clinicians generated 85 critical incidents. Three categories of impact were identified: impact on clinical practice, impact on individual clinicians and impact on colleagues through the dissemination of information gained from the online evidence system. One quarter of these included specific examples of system use leading to improvements in patient care. Clinicians obtained an average journey mapping score of 22 out of a possible score of 36, demonstrating a good level of system integration. Average scores of doctors and CNCs were similar. However individuals with the same scores often had very different journeys in system integration.
The CI technique provided clear examples of the way in which system use had influenced practice and care delivery. The JM technique was found to be a useful method for providing a quantification of the different ways and extent to which, clinicians had integrated system use into practice, and insights into how system use can influence organisational culture. The development of the journey mapping stages provides a structure by which the program logic of a clinical information system and its desired outcomes can be made explicit and be based upon users' experiences in everyday practice. Further work is required using this technique to assess its value as an evaluation method.
在线证据检索系统是支持循证实践的一种潜在工具。用于评估这些系统对医疗服务提供和患者结局影响的有效且经过测试的技术有限。
在本研究中，我们应用关键事件（CI）和旅程映射（JM）技术来评估在线证据系统融入日常临床实践的情况及其对决策和患者护理的影响。为引出事件，我们对29名临床医生（13名医院内科专科医生、16名临床护士顾问（CNC））进行了半结构化访谈，他们都是在线证据系统的经验丰富用户。还询问了临床医生关于他们首次使用该系统的方式以及他们的使用情况和体验如何随时间变化。然后使用旅程映射技术对这些叙述性描述进行映射和评分。
临床医生共提出85个关键事件。确定了三类影响：对临床实践的影响、对个体临床医生的影响以及通过传播从在线证据系统获得的信息对同事的影响。其中四分之一包括系统使用导致患者护理改善的具体例子。临床医生在旅程映射中的平均得分为22分（满分36分），表明系统集成水平良好。医生和CNC的平均得分相似。然而，得分相同的个体在系统集成过程中的经历往往差异很大。
CI技术提供了系统使用影响实践和医疗服务提供方式的清晰示例。发现JM技术是一种有用的方法，可用于量化临床医生将系统使用融入实践的不同方式和程度，并深入了解系统使用如何影响组织文化。旅程映射阶段的发展提供了一种结构，通过该结构可以明确临床信息系统的程序逻辑及其预期结果，并以用户在日常实践中的经验为基础。需要进一步开展工作，利用该技术评估其作为一种评估方法的价值。
