Engelmann Carsten, Ametowobla Dzifa
Carsten Engelmann, MD, PhD, Department of Pediatric Surgery, Klinikum Brandenburg, Medical University Brandenburg Theodor Fontane, Hochstr. 29, 14770 Brandenburg, Germany, Email:
Appl Clin Inform. 2017 May 17;8(2):515-528. doi: 10.4338/ACI-2016-06-RA-0100.
Planning and controlling surgical operations hugely impacts upon productivity, patient safety, and surgeons' careers. Established, specialized software for this task is being increasingly replaced by "Operating Room (OR)-modules" appended to enterprise-wide resource planning (ERP) systems. As a result, usability problems are re-emerging and require developers' attention.
Systematic evaluation of the functionality and social repercussions of a global, market-leading IT business control system (SAP R3, Germany), adapted for real-time OR process steering.
Field study involving document analyses, interviews, and a 73-item survey addressed to 77 qualified (> 1-year system experience) senior planning executives (end users; "planners") working in surgical departments of university hospitals.
Planners reported that 57% of electronic operation requests contained contradictory information. Key screens contained clinically irrelevant areas (36 +/- 29%). Compared to the legacy system, users reported either no improvements or worse performance, in regard to co-ordination of OR stakeholders, intra-day program changes, and safety. Planners concluded that the ERP-planning module was "non-intuitive" (66%), increased planning work (56%, p=0.002), and did not impact upon either organizational mishap spectrum or frequency. Interviews evidenced intra-institutional power shifts due to increased system complexity. Planners resented e.g. a trend towards increased personal culpability for mishap.
Highly complex enterprise system extensions may not be directly suited to specific process steering tasks in a high risk/low error-environment like the OR. In view of surgeons' high primary task load, the repeated call for simpler IT is an imperative for ERP extensions. System design should consider a) that current OR IT suffers from an input limitation regarding planning-relevant real-time data, and b) that there are social processes that strongly affect planning and particularly ERP use beyond algorithms. Real improvement of clinical IT tools requires their independent evaluation according to standards developed for pharmaceutical subjects.
手术操作的规划与控制对生产力、患者安全以及外科医生的职业生涯有着重大影响。用于此项任务的成熟专业软件正日益被附加到企业资源规划（ERP）系统中的“手术室（OR）模块”所取代。结果，可用性问题再次出现，需要开发者予以关注。
对一款全球领先的IT商业控制系统（德国的SAP R3）进行功能和社会影响的系统评估，该系统适用于手术室流程的实时控制。
进行实地研究，包括文件分析、访谈，并向大学医院外科科室的77名资深规划主管（最终用户；“规划人员”）发放一份包含73个项目的调查问卷，这些主管具备一年以上系统使用经验。
规划人员报告称，57%的电子手术申请包含相互矛盾的信息。关键屏幕包含与临床无关的区域（36%±29%）。与旧系统相比，在手术室利益相关者的协调、当日程序变更和安全性方面，用户报告称没有改进或性能更差。规划人员得出结论，ERP规划模块“不直观”（66%），增加了规划工作（56%，p = 0.002），并且对组织事故范围或频率均无影响。访谈证明，由于系统复杂性增加，机构内部发生了权力转移。规划人员不满例如事故个人罪责增加的趋势。
高度复杂的企业系统扩展可能并不直接适用于手术室这种高风险/低容错环境中的特定流程控制任务。鉴于外科医生的主要任务负荷很高，反复呼吁采用更简单的信息技术对于ERP扩展来说势在必行。系统设计应考虑：a）当前手术室信息技术在规划相关实时数据的输入方面存在限制；b）存在一些社会过程，这些过程强烈影响规划，尤其是超出算法的ERP使用。临床信息技术工具的真正改进需要根据为药物主题制定的标准对其进行独立评估。
