Summary
Background: Availability and usage of individual IT applications have been studied intensively
in the past years. Recently, IT support of clinical processes is attaining in-creasing
attention. The underlying construct that describes the IT support of clinical work-flows
is clinical information logistics. This construct needs to be better understood, operationalised
and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite
score (WCS) for measuring clinical information logistics and to examine its quality
based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining
and conceptualising the construct domain, for developing the measurement instrument,
assessing the content validity, pre-testing the instrument, specifying the model,
capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information,
function, integration and distribution, which embraced the framework validated by
an analysis of the international literature. This framework was refined selecting
representative clinical processes. We chose ward rounds, pre- and post-surgery processes
and discharge as sample processes that served as concrete instances for the measurements.
They are sufficiently complex, represent core clinical processes and involve different
professions, departments and settings. The score was computed on the basis of data
from 183 hospitals of different size, ownership, location and teaching status. Testing
the reliability and validity yielded encouraging results: the reliability was high
with rsplit-half = 0.89, the WCS discriminated between groups; the WCS correlated
significantly and moderately with two EHR models and the WCS received good evaluation
results by a sample of chief information officers (n = 67). These findings suggest
the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support
of clinical workflows according to validated descriptors a high portability of the
WCS to other hospitals in other countries is very likely. The WCS will contribute
to a better understanding of the construct clinical information logistics.
Keywords
Clinical workflows - IT support - clinical information logistics - workflow management
- composite score - validation
