budgets in the U.S. health care industry have historically been low but are
expected to grow to $39.5 billion
through 2008 [ 10]. Our findings suggest that knowing more about the
actual benefits derived from UA by
studying use at the work process level
may spark increased acceptance. At
the same time, UA is not without
meaningful adoption and usage issues
[ 8]. This is especially true in health
care contexts [ 12].
We selected medical units employing UA for various tasks at the point
of care in three hospitals. Technologies supporting UA were lightweight
computers mounted on carts to allow
mobility (see the accompanying figure). Table 1 provides hospital characteristics and summarizes our data
collection. The data was collected
post-implementation, when UA had
been operational in each unit for at
least three months. We interviewed
nurses, managers, and information
systems personnel at each hospital. Mobile UA cart.
We summarize the findings before
discussing our recommendations:
UA provides nurses with essential information at the
point of care. UA reduces nurses’ charting time and
anxiety, enabling them to stay longer with patients and
chart multiple patients simultaneously. UA helps
nurses create comprehensive, readily accessible records
for any authorized personnel to review in real time.
This relieves them from having to communicate
patient information orally. Even though UA may promote reduced socialization among nurses, which people external to the context may perceive as an
impediment to acceptance, it is balanced by the efficiency improvements in the work process (such as
decreased time for task completion and less congestion
at central computing points). Vital information can be
difficult to transmit even among willing parties. UA
increases in value when systems facilitate detailed
records-keeping, reduce charting time, and enhance
readability. Consider the following quote from a triage
nurse:
“The main benefit...is that you can look up information about their previous care—how many times
they have been here for the same complaint—as you
triage. Some don’t want to tell you that they are HIV
patients, so when you review their history you can see
that... [UA] makes the triage process quicker. [Before
UA] by the end of the day, your hand’s cramping. You
forget some things or can’t read
what you wrote, which can cause
you to make mistakes.”
UA automates the documentation and knowledge inquiry portion of the work process. It also
informs in that it provides nurses
and intended medical personnel
with extensive mutual awareness of
the situation in which they are
involved [ 4]. UA supports more
timely and efficient information
analysis in negotiations between
medical personnel concerning
aspects of the care-delivery process.
For example, in medication
administration, if a nurse believes
the prescription to be erroneous or
not effective, the nurse can enter an
inquiry in the system to more efficiently alert the physician and
pharmacists via an integrated messaging system. This process is less
convoluted and time-consuming
than the use of manual records.
Benefits and limitations influencing acceptance of UA.
Primary benefits that promote acceptance are:
• Reduced time required to validate questionable
drug prescriptions and medical interventions,
which can delay patient care;
• Greater ability for nurses (and subsequently the
hospital) to defend against accusations of, and liability for, negligent care;
• Easier and timelier quality assurance for processes
and verification associated with patient care; and
• Greater ability for registration personnel and nurses
to maintain patient confidentiality by silently
reviewing existing information. Also, UA can offer
resources of needed information for situated action.
For example, nurses can better negotiate with
patients to comply with medication regimens by
using the system as a medium at the point of care.
As a nursing informatics director reports:
“You can use the computer system to be a part of the
[patient and caregiver] relationship. You develop interfaces with graphics that the doctor [or nurse] can use
to better explain conditions to the patient. For example, you can create a graph of depicting how a patient’s
blood sugar is not under control based on historical
data. You can show them and ask: ‘What are they
doing? Are they not taking the medication?’ Or you
can say, ‘You are doing very well on this weight reduc-