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The Use of Computers for Clinical Care: A Case Series of Advanced U.S. Sites

Affiliations of the authors: Director of Clinical Services, Greater Newcastle Sector, Hunter Health, Newcastle, New South Wales, Australia (DFD); Chief, General Medicine Division and Primary Care, Brigham and Women’s Hospital; Medical Director, Clinical and Quality Analysis, Partners HealthCare System, Boston, Massachusetts (DWB); Executive Director, Institute for Health Care Delivery Research, Vice-President for Medical Research, Intermountain Health Care, Salt Lake City, Utah (BCJ).

Correspondence and reprints: David W. Bates, MD, MSc, Chief, General Medicine Division and Primary Care, Brigham and Women’s Hospital; Medical Director, Clinical and Quality Analysis, Partners HealthCare System, 75 Francis Street, Boston, MA 02115; e-mail: <dbates{at}partners.org>

Abstract Objective: To describe advanced clinical information systems in the context in which they have been implemented and are being used.

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

Measurements: 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.

Conclusion: 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.

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