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Discovering How to Think about a Hospital Patient Information System by Struggling to Evaluate It: A Committee’s Journal

^a Departments of Pediatrics and Public Health, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY
^b Departments of Biomedical Informatics and Pediatrics, Columbia University, New York Presbyterian Hospital, New York, NY

^_* Correspondence and reprints: Joseph Schulman, MD, MS, Department of Pediatrics, Division of Newborn Medicine, Weill Medical College of Cornell University, 525 East 68th Street, Box 106, New York, NY 10065 (Email: jos2039{at}med.cornell.edu).

Received for publication: 03/13/07; accepted for publication: 05/28/07.

Parallel to the monumental problem of replacing paper-and-pen–based patient information management systems with electronic ones is the problem of evaluating the extent to which the change represents an improvement. All clinicians must grapple with this daunting challenge; those with little or no informatics expertise may be particularly surprised by the attendant difficulties. To do so successfully, they must be able to explicitly conceptualize the daily clinical work—a prerequisite for appreciating and reasonably evaluating it. Further, few of these evaluators may have reflected on the dynamic interaction between their work and their tools—how changing a tool necessarily changes the work. This article illuminates these problems by telling the story of how one patient care information systems committee first learned to think about the purpose of a patient information management system, and second, how to evaluate the impact of its implementation.