Summary
Objective:
The failure of a promising system is described with the aim of identifying the errors
and the unfavourable conditions that led to such a result.
Methods:
The system, based on the AHCPR guideline for pressure ulcers prevention and integrated
into the already existing clinical information system, is aimed at supporting nurse’s
activities for: the risk assessment of the inpatient at the beginning of the hospitalization;
the prevention plan, customized to each specific patient; the work plan for each day
for all the patients; the report of the non-compliances to the GL and of the workload
of the nurses.
Results:
The system was abandoned after a short period. The reported reasons for the abandonment
were: too strict constraints in the work-plan and the mandatory updating of the tasks
at the end of each shift (both executed and not); the double writing activity, on
paper first and afterward on the workstation.
The first complaint was almost unrecoverable and not related to the system from the
implementation point of view. Portable notebooks and wireless connections to the LAN
could have been a solution for the second problem. Simultaneously a portable device
at the bed side could have benefited many other features of the clinical information
system. We proposed to quantify the added value, if any, due to making the information
system available as close as possible to the points on the wards where information
are both generated and used. The proposal was rejected.
Conclusions:
In our experience in a hospital setting, closing the gap among the medical informatics
minority, the health professionals and the hospital management, through their collaborative
responsibilities and participation in the decision-making process, can make the difference
between the success and the failure of a good computer-based solution.
Keywords
Applied medical informatics - success factors - guidelines - evaluation - political
factors
