Digitising an Australian university hospital: qualitative analysis of staff-reported impacts
Rebekah Eden
A G , Andrew Burton-Jones B , James Grant C , Renea Collins C , Andrew Staib C D and Clair Sullivan E F
A Information Systems School, Science and Engineering Faculty, Queensland University of Technology, 2 George Street, Brisbane, Qld 4000, Australia.
B UQ Business School, The University of Queensland, Blair Drive, St Lucia, Qld 4072, Australia. Email: abj@business.uq.edu.au
C Clinical Excellence Queensland, eHealth Queensland, Department of Health, Butterfield Street, Herston, Qld 4006, Australia. Email: james.grant@health.qld.gov.au; renea.collins@health.qld.gov.au
D Metro South Hospital and Health Service, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: andrew.staib@health.qld.gov.au
E Metro North Hospital and Health Service, Herston Road, Herston, Qld 4006, Australia. Email: clair.sullivan@health.qld.gov.au
F Faculty of Medicine, The University of Queensland, St Lucia, Qld 4072, Australia.
G Corresponding author. Email: rg.eden@qut.edu.au
Australian Health Review 44(5) 677-689 https://doi.org/10.1071/AH18218
Submitted: 16 October 2018 Accepted: 26 March 2019 Published: 18 July 2019
Abstract
Objective This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation.
Methods A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation.
Results Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management; (2) mixed findings for the availability of real-time data; and (3) positive findings for the secondary use of data.
Conclusions The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation.
What is known about the topic? Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely reported.
What does this paper add? This study provides a qualitative assessment of the effects of an eHealth transformation at a large Australian tertiary hospital. The results provide renewed confidence in the literature because the findings are largely consistent with expectations from prior systematic reviews of impacts. The qualitative approach followed also resulted in the identification of new effects, which included improvements in accountability, time management and individual development, as well as mixed results for real-time data. In addition, substantial improvements in patient outcomes and clinician productivity were reported from the secondary use of data within the eHealth systems.
What are the implications for practitioners? The overall positive findings in this large case study should give confidence to other health services contemplating rapid digital transformation. To achieve substantial benefits, hospitals need to understand how they can best leverage the data within these systems to improve the quality and efficiency of patient care. As such, both research and practice need to shift towards understanding how these systems can be used more effectively.
Additional keywords: case study, electronic medical records, evaluation, health information systems.
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