title: Changes, disruption and innovation: An investigation of the introduction of new health information technology in a microbiology laboratory.
abstract: BACKGROUND
  It is expected that health information technology (HIT) will deliver a safer, more efficient and effective health care system. The aim of this study was to undertake a qualitative and video-ethnographic examination of the impact of information technologies on work processes in the reception area of a Microbiology Department, to ascertain what changed, how it changed and the impact of the change.
  
  
  METHODS
  The setting for this study was the microbiology laboratory of a large tertiary hospital in Sydney. The study consisted of qualitative (interview and focus group) data and observation sessions for the period August 2005 to October 2006 along with video footage shot in three sessions covering the original system and the two stages of the Cerner implementation. Data analysis was assisted by NVivo software and process maps were produced from the video footage.
  
  
  RESULTS
  There were two laboratory information systems observed in the video footage with computerized provider order entry introduced four months later. Process maps highlighted the large number of pre data entry steps with the original system whilst the newer system incorporated many of these steps in to the data entry stage. However, any time saved with the new system was offset by the requirement to complete some data entry of patient information not previously required. Other changes noted included the change of responsibilities for the reception staff and the physical changes required to accommodate the increased activity around the data entry area.
  
  
  CONCLUSIONS
  Implementing a new HIT is always an exciting time for any environment but ensuring that the implementation goes smoothly and with minimal trouble requires the administrator and their team to plan well in advance for staff training, physical layout and possible staff resource reallocation.
authors.affiliation: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, University of New South Wales, Faculty of Medicine, Level 1, AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: George
authors.initials: G
authors.lastname: Toouli
authors.forename: Andrew
authors.initials: A
authors.lastname: Georgiou
authors.forename: Johanna
authors.initials: J
authors.lastname: Westbrook