Professional and organizational impact of using patient care information systems.

Evaluation of information systems has often been limited to success factors in relation to system implementation (on time and on budget), training and use of the system. Little attention has been paid to the longer-term effect of using these systems and the resulting issues for health care professionals and organizations. This paper reports on a multiple case study of community hospitals, which examined the impact of using Patient Care Information Systems. An analytic framework incorporated Donabedian's 3 aspects of quality care: structure, process and outcome. These were examined at three levels of impact; direct substitution, proceduralization and new capabilities. Many of the anticipated benefits in the study did not occur because changes occurring in structure (generally taks done by pharmacists and laboratory technologists) did not automatically influence process changes (such as decision making of physicians and nurses) or patient outcomes. Four themes illustrate important professional and organizational issues with implications for worklife of professionals, management and career training. They include the effects of increased efficiency and productivity; "visible" accountability; changing roles and responsibilities; and learning to use new technology versus using new information.