Table 1

Conceptual Framework for Probing Clinicians’ Experience Using a Patient Information Management System

Dimension of IT tool use: Work Flow

Data retrieval
Individual patients
Aggregates of patients
How soon after creation is a record available?
Interruptions: when distracted by a competing task, do users lose track of thoughts and where they were in the record by the time they return to it, or does the tool remember for them?
System response time; down time
Ease of system access
Feature navigation: ease, and possibility to toggle between features
Juxtaposition error: is a data element so close to something else on the screen that the wrong option may easily be clicked or an item read in error?
Have users devised workarounds? That is, have users devised strategies and tactics enabling them to live with the system despite demands they deem unrealistic, inefficient, or harmful?
To what extent does this tool promote entering information only once, but enable presenting it in varied contexts?

Dimension of IT tool use: Cognitive Enhancement/impedance

Does this tool overwhelm users (cause cognitive overload) by overemphasizing structured and “complete” information entry alerts and reminders?

Does this tool cleave information that belongs together, forcing users to switch between different screens, so that users feel deprived of the overview desired?

Are readability and information value of reports diminished by over-use of standard phrases?

Does the availability of these standard phrases discourage users’ composing thoughts and crafting meaning?
As users read a narrative, is understanding sometimes confounded by uncertainty whether a sentence or clause represents thoughtful word use—a spot-on description; or merely a conveniently available selection—a more or less apropos description?

Are data provided as abstract cues, or do they contain sufficient context to establish their referential function?¹
Do users feel that they function more as data entry workers or as knowledge workers?

Do users feel that their identity as a professional has changed by using this tool? If so, how?

To what extent does this tool draw out users’ intellect in working with the data and aid their creating meaning from it?¹

Dimension of IT tool use: Communication

To what extent do users think that another professional reviewing their entry will grasp the essence of what they intended to communicate?

Do users think that “entering” their contribution to the patient record replaces their previous means of initiating and communicating their plans?
Have users noticed a change in the amount of direct interaction among physicians, nurses, and pharmacy? If so, in what direction?

Has overall reliance on the computer system as a source of answers to clinical questions increased, decreased, or stayed the same?

Dimension of IT tool use: Work/tool Interaction

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