The use of computers for clinical care: a case series of advanced U.S. sites.
OBJECTIVE
To describe advanced clinical information systems in the context in which they have been implemented and are being used.


METHODS
Case series of five U.S. hospitals, including inpatient, ambulatory and emergency units. Descriptive study with data collected from interviews, observations, and document analysis.


METHODS
The use of computerized results, notes, orders, and event monitors and the type of decision support; data capture mechanisms and data form; impact on clinician satisfaction and clinical processes and outcomes; and the organizational factors associated with successful implementation.


RESULTS
All sites have implemented a wide range of clinical information systems with extensive decision support. The systems had been well accepted by clinicians and have improved clinical processes. Successful implementation required leadership and long-term commitment, a focus on improving clinical processes, and gaining clinician involvement and maintaining productivity.


CONCLUSIONS
Despite differences in approach there are many similarities between sites in the clinical information systems in use and the factors important to successful implementation. The experience of these sites may provide a valuable guide for others who are yet to start, or are just beginning, the implementation of clinical information systems.
Doolan
David F
DF
Clinical Services, Greater Newcastle Sector, Hunter Health, Newcastle, New South Wales, Australia.
Bates
David W
DW
James
Brent C
BC
D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical / Q000458:organization & administration / Q000706:statistics & numerical data; D006751:Hospital Information Systems / Q000458:organization & administration / Q000706:statistics & numerical data; D016347:Medical Records Systems, Computerized; D019982:Organizational Case Studies; D009936:Organizational Innovation; D014481:United States