Development of a health information system to promote emergency care pathways: A participatory design study

Abstract

Objective The successful development and implementation of sustainable healthcare technologies require an understanding of the clinical setting and its potential challenges from a user perspective. Previous studies have uncovered a gap between what emergency departments deliver and the needs and preferences of patients and family members. This study investigated whether a user-driven approach and participatory design could provide a technical solution to bridge the identified gap. Methods We conducted four workshops, and five one-to-one workshops with patients, family members, healthcare professionals, and information technology specialists to codesign a prototype. Revisions of the prototype were made until an acceptable solution was agreed upon and tested by the participants. The data were analyzed following iterative processes (plan → act → observe → reflect). Results The participants emphasized the importance of a person-centered approach focusing on improved information. An already implemented system for clinicians’ use only was redesigned into a unique patient module that provides a process line displaying continually updated informative features, including (1) person-centered activities, (2) general information videos, (3) a notepad, (4) estimated waiting time, and (5) the nurse and physician responsible for care and treatment. Conclusion Participatory design is a usable approach to designing an information system for use in the emergency department. The process yielded insight into the complexity of translating ideas into technologies that can actually be implemented in clinical practice, and the user perspectives revealed the key to identifying these complex aspects. The iterations with the participants enabled us to redesign an existing technology.

Usability and Evaluation of a Health Information System in the Emergency Department: Mixed Methods Study

“…Echoing these findings, Verma et al [ 39 ] investigated the level of eHealth literacy among older adults and caregivers and found that one main barrier to the adoption of eHealth was a lack of familiarity with the tools available. In the development phase of CCL for patients [ 16 ], decisions had to be made for the system to work in a clinical setting. One decision was the use of an interface design, which did not allow us to integrate well-known functions, for example, from email or application symbols.…”

“…An update of the Medical Research Council’s guidelines for developing and evaluating complex interventions in health care states that appropriate users should be involved in every part of the development, process, and outcome analysis of a complex intervention to ensure sustainable interventions [ 50 ]. In line with best practices, the information system has been developed together with representatives of future users of the system, including health care professionals, managers, patients, family members, and IT specialists [ 16 ]. For decades, the ED context has been a hectic environment [ 4 , 42 , 51 , 52 ].…”

“…Based on the current findings, patients in the ED and their family members have unmet information needs [ 1 - 4 ]. Hence, guided by the principles of user-driven activities [ 15 ], a health information system was developed [ 16 ]. The health information system, which is called “Cetrea Clinical Logistic (CCL) for patients ,” is available for patients in the hospital’s emergency room and displays real-time information, including (1) person-centered activities, (2) information videos, (3) a notepad, (4) waiting time, and (5) the nurse and physician responsible for care.…”

“…In the initial phase, the author group identified the essential needs of patients in the ED, their family members, and ED clinicians [ 2 , 3 ]. The results from phase 1 informed the second phase, in which an information system, CCL for patients, was developed in a cocreation process [ 16 ]. The third phase involved testing and evaluation of the system, which is reported in this study.…”

“… Cetrea Clinical Logistics (CCL) for patients and its functionalities, as displayed to patients and their family members, developed in the second phase of the overall study (the figure has been previously published by Østervang et al [ 16 ]). (1) Number of the ED room.…”