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informatics and eHealth initiatives in Australasia, which may be driven by a national, state or specialist area of interest perspective. focusing on the post-implementation phase of projects and initiatives considered of interest to the broader health informatics community. offering in-principle support to relevant research and evaluation activities undertaken, or requested by, any independent bodies such as university departments and private consultants. undertaking research and evaluation activities alone, or in association with independent bodies such as university departments and private consultants. acting as a vehicle to crystallise the opinion of college fellows in relation to issues that pertain to associated program and evaluation activities. Such opinions in turn can help in the creation of position statements on behalf of the college. publishing its findings internal and external to the college via different media as it sees appropriate for the context of the dialogue. This may include for example, reporting via external academic literature, or reporting internally via the college council. undertaking all of the above-mentioned activities in a way that is transparent in relation to potential conflicts of interest, and in a way in which true independence of analysis is considered as a defining characteristic of the work.
Implementation complexity Implementing a healthcare system is inherently complex and therefore also complex to evaluate. One need only to look at the debate over the ‘success’ or ‘failure’ of the NHS program to understand the problem. The level of complexity increases exponentially the larger the system and the number of stakeholders. Often, patientfocused outcomes seem secondary to funding or political considerations.
“The aim of the PES is to ultimately be seen as the authoritative and truly independent source of advice for health industry stakeholders, government and the media.” Dr Chris Bain and A/Prof Chris Pearce
A truism in health informatics is “what is the problem you are trying to solve?” In turn, the question must be asked for any given system implementation: “What constitutes success?” Any single (or combination of) outcome(s) below may indicate a useful system, successfully implemented.
• The level of support for the use of the system amongst users • The ability of the organisation to sustain any change in work practices associated with the system implementation and utilisation • The usability of the system.
Usability
• Reduced clinical errors, for example prescribing errors • Reduced clinician workload, for example chasing paper copies of test results • Improved access to care • Financial improvements, such as increased income from billing or improved debt recovery • System implemented on time and within budget • Improved patient satisfaction • Improved healthcare worker satisfaction • Reduced delays in patient discharge from inpatient care
This last point needs to be emphasised. The concept of usability is one poorly understood by many people who refer to it. There are highly qualified individuals whose entire job is the design and testing of systems (including various electronic devices and software systems) from a usability perspective.
Furthermore, some of the drivers that may be considered in establishing the relative success or failure of an implemented system include:
These evaluations are not for the faint‑hearted nor for those not appropriately qualified. In particular, there is an enormous amount of contextual knowledge to be factored in order for such evaluations to be undertaken in an informed fashion. For example, there has been decades of work already in the areas of systems success and failure4 and of user
• The length of time since implemented • The technical stability of the system • The quality of the implementation of the system
Usability is not simply how “easy to use” a system is. It can be broken down into its constituent components, and these in turn can be measured. These components include the flexibility of the system, its speed, its ease of navigation, its ease of learning and its “attitude”.3
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