What is the Impact of Technology?
Haleh Ayatollahi
, Peter A. Bath
and Steve Goodacre
Health Informatics Research Group, Department of Information Studies, University of Sheffield
Regent Court, 211 Portobello Street, Sheffield, U.K.
Iran University of Medical Sciences, Hemmat Highway, Tehran, Iran
Emergency Department, Northern General Hospital, Herries Road, Sheffield, U.K.
Keywords: Emergency Department, information system, impact.
Abstract: Emergency Department Information Systems (EDIS) are commonly used to improve access to patient
information at the point of care. While such systems hold great promise, there has been little research
evaluating the impact of these systems. To investigate the Emergency Department (ED) staff perceptions of
the impact of computerised information systems in this department, a qualitative study was conducted. In
this study, data were collected using in-depth semi-structured interviews with the ED staff. In total, 34
interviews were conducted and data were analysed using framework analysis. . The results showed that the
impact of information systems could be categorised as individual impact, organisational impact, and impact
on patient care. The impact of technology could be positive (e.g., improving the accessibility of
information) or negative (e.g., interrupting staff workflow due to system downtime). The results suggest
that although clinical information systems are designed to influence clinical practice positively, the
likelihood of the negative impacts should not be underestimated. Evaluation studies are needed to
investigate the impact of technology as a measure for system success or failure.
In recent years the use of information technology in
Emergency Departments (EDs) has increased, due to
attempts to improve the accessibility of information,
reduce errors in clinical practice, eliminate
documentation errors, and to improve the
completeness of data (Harper, 2001). However, the
implementation of new technology into a complex
environment, such as an ED, may result in
unforeseen consequences, such as negative effects
on clinical practice (Embi et al., 2004). For
example, an increase in the amount of time that is
spent on a computer and a reduction in the time
spent on caring for patients, or a lack of fit between
the system features and users’ work may all have a
negative impact on clinical practice (Rose et al.,
A number of evaluation studies have been
undertaken to explore the impact of information
systems in different settings; however, little has been
reported about the impact of using information
technology in the ED. Since the ED has special
characteristics in terms of the variety of patients and
the speed of work (Amouh et al, 2005), investigating
users’ perceptions of the impact of computerised
information systems could help to identify factors
that may influence the success or failure of systems.
This can be also useful for developing and
implementing information systems in the future.
The aim of the present study was to investigate
users’ perceptions of, and interactions with EDIS.
The objectives were to identify issues that might
influence the use of EDIS, and to compare users’
perspectives about these issues.
This was a qualitative study conducted in March-
April 2007. A qualitative approach was applied to
gain a better, and in-depth, understanding of the
context, and factors that might influence the use of
information systems in the ED. The research setting
Ayatollahi H., Bath P. and Goodacre S. (2009).
IT IN THE EMERGENCY DEPARTMENT - What is the Impact of Technology?.
In Proceedings of the International Conference on Health Informatics, pages 454-457
DOI: 10.5220/0001539504540457
was an ED located in a large urban teaching hospital
in northern England. The ED in this hospital is
particularly busy as it is the only major one in the
city responsible for providing emergency care for
adult patients. In this department, paper-based
records are used as the main source of information
(e.g. medical records, patient notes, ED cards).
However, the ED’s electronic information systems
include a Patient Focus Information System (PFIS),
a patient tracking system, and a Radiology
Information System, although these are not
integrated with each other. The access level is
different for different user groups.
In order to collect data, semi-structured
interviews were chosen as the most appropriate
method, as the aim of the study was to investigate
users’ perceptions. This would help to gather more
in-depth data. In this study, convenience sampling
was used to recruit the participants. However, in
order to have a broader picture of users’ perceptions,
different members of staff who used the information
systems were interviewed. The interviews were
digitally recorded (with the participants’ consent)
and were transcribed verbatim. To analyse the
interview data, the method of framework analysis
was used (Ritchie and Spencer, 1994). In this study,
data were analysed by one of the researchers (HA),
and to facilitate coding data, computer software
QSR NVIVO 7 was used. In order to check the
validity of results, member checking was used and
the interviewees asserted the accuracy of the results.
Thirty-four ED members of staff were interviewed
in total. The interviews lasted between 20 and 70
minutes (mean = 43 minutes). The participants of
the study were the ED staff (Doctors, Nurses, and
Administrative staff) who used at least one of the
information systems in the ED. Nine participants
were male and 25 were female. The age range was
25 to 57 years old.
A key theme that emerged from the data analysis
was the perceived impact of IT. The results
suggested that the impact of IT could be sub-divided
into individual impact, organisational impact, and
impact on patient care.
3.1 Individual Impact
The results suggested that if the ED staff were asked
to use a new computerised information system, some
of them might experience feelings such as fear,
stress, and nervousness. Such feelings could mostly
be experienced when a change happened in their
work practices, for instance, when they had to enter
data into the computer rather than writing it on
paper. In relation to this, a doctor said:
‘I have never used a fully computerised system,
so I am still a little bit nervous about that, I think my
nervousness, from the bits that I have used has gone’
[Doctor 10].
Some interviewees mentioned that, not only in
the early stages of introducing a new system, but
also after getting used to using it, any problem with
the system, such as system downtime could make
them ‘panic’.
‘If the system goes down, you are absolutely lost
because you can’t look for anything. You know, you
are hopeless’ [Administrative staff 1].
From the users’ perspectives, the positive
impacts were mainly associated with having easier
and quicker access to the information that they
needed. This could help the clinicians to provide
patients with a better care plan in a timely fashion.
As a doctor noted:
‘…, it would make the day run much more
smoothly, so you go home without having to worry
about you have tried to guess some’ [Doctor 8].
In terms of the negative impacts, although most
of the interviewees believed that the current ED
systems were easy-to-use, some of them
remembered that using these systems at the
beginning affected their work negatively.
The tracking system, when they first introduced
it, you spent your time treating the tracking system
and not treating patients’ [Doctor 10].
…, we didn’t like it (patient tracking system)
when we first started it, because we thought it was
an extra job we weren’t supposed to,…
[Administrative staff 8].
In fact, a lack of fit between the staff work flow
and the way that the system worked could be a
reason for this negative impact.
3.2 Organisational Impact
As some of the staff were responsible for managerial
tasks in the department, using computerised
information systems could also facilitate their jobs.
The accessibility of information helped them to
make better decisions at the departmental and
organisational level. As a doctor noted:
It has completely changed how we work really.
I can pick up doctors who are failing for various
reasons… you can look at the doctors who x-ray
every single patient that they see’ [Doctor 10].
IT IN THE EMERGENCY DEPARTMENT - What is the Impact of Technology?
The accessibility of information had, in turn,
helped to increase efficiency in the department. The
use of information systems had also improved data
communication in the ED. For example, the ED
staff could use the patient tracking system to add
notes regarding a patient’s status, and the rest of the
ED staff could be informed about that by using the
system. With reference to this, a nurse commented:
‘That computer (patient tracking system) helps
us to communicate by putting information on that’
[Nurse 8].
However, most of the interviewees mentioned
that system downtime had a significant negative
impact on their work since they could not have
access to information that they needed. This
situation was a ‘nightmare’ and caused ‘chaos’, as
mentioned by several interviewees.
3.3 Impact on Patient Care
This sub theme included the positive, neutral, and
negative impact of using information systems on
patient care. Most of the interviewees agreed that
the use of information systems had a positive impact
on patient care, mainly in terms of improving the
speed of care and saving time for clinical tasks,
reducing clinical error, increasing effectiveness, and
improving patient safety.
‘…, you would reduce the risk of things like one
patient’s x-ray being put in another patient’s packet.
So, it would reduce the risk of any incident and
possibly it would reduce the negligence cases
[Nurse 5].
A number of participants indicated that
information systems could improve the accessibility
of information and the more information they had,
the better and quicker were the clinical decisions
While most of the interviewees stated that using
information systems had a positive impact on patient
care and could improve it, a few of the interviewees
asserted that using information technology had no
effect on patient care:
It usually speeds things up for beds and
provides the methods of doing order, research and
something, because you have got data available.
But, it doesn’t affect the individual patient care very
much, I don’t think’ [Doctor 4].
Moreover, some of the interviewees were
concerned about the negative impacts of information
systems on patient care. From their point of view,
system characteristics that might cause them to
spend too much time on a computer rather than on
patient care, or the low quality information on the
systems, could adversely affect patient care.
‘If it (a computerised information system) is too
time-consuming to put in the information, then that
may be detrimental to the patient care’ [Nurse 5].
These results suggest that not only the technical
aspects of a system (e.g., hardware and software)
should be taken into account, but also the non-
technical aspects, such as data quality, need to
receive adequate attention.
Clinical information systems are mainly designed
and implemented to improve efficiency,
effectiveness, and the quality of patient care in the
healthcare settings. While these systems are
expected to meet their targets, a number of technical
and non-technical reasons may result in adverse
Regardless of being positive or negative, the
impact of computerisation has been categorised in
several studies. For example, van der Meijden et al.
(2003) focused on the individual and organisational
impacts of computerisation. From their perspective,
the individual impacts attributes included changed
clinical work patterns, changed documentation
habits, efficiency and effectiveness of work. The
attributes of the organisational impact included
communication and collaboration, impact on patient
care and cost. Despont-Gros et al. (2005, p. 251)
concentrated on the impact of computerisation from
a user’s point of view. The authors suggested that
the impact of computerisation can be categorised
either as ‘real impacts’, such as a change in
communication patterns or workflow or as
‘perceived impacts’ such as a feeling of being
controlled or stressed to work in a standardised way.
Raitoharju (2005) focused on IT-related stress as one
of the individual impacts of computerisation.
The results of the current study suggest that, in
order to investigate the impact of clinical
information systems, a combination of the above-
mentioned areas should be taken into account. In
terms of the individual impact of technology, it is
notable that the nature of working in a healthcare
setting, particularly in the ED, may be stressful for
the staff (Raitoharju, 2005). Hence, it is important
to understand how their IT-related stress can be
reduced or eliminated, rather than adding to their
work stress. According to the results, as introducing
a system to a work environment may have a negative
impact at the beginning, ongoing training in the use
HEALTHINF 2009 - International Conference on Health Informatics
of the system and more communication with users
should be considered to improve their understanding
of the system (Campbell et al., 2006).
The impact of using information systems on
patient care seemed to be an arguable issue.
However, it seems that a system that is able to meet
clinicians’ expectations can help them to make better
decisions, and can help to improve patient care.
Overall, the results suggest that, from the user’s
perspective, the systems’ benefits far outweighed
any negative effects, and none wanted to give up the
systems. In order to reduce the potentially negative
impact of using technology, before designing and
implementing information systems the current
workflow should be investigated and re-designed if
In this study, data were collected from only one
Emergency Department where specific information
systems were used. As a result, the findings may not
be fully transferable to other settings in which other
systems are in use. In addition, our sampling
method was limited by the need to fit in with staff
working patterns, so we had to use convenience,
rather than purposive, sampling. However, the
results could be useful for developing and
implementing clinical information systems,
particularly in the Emergency Department, in the
In this paper, we showed that the use of clinical
information systems might affect three main aspects:
the users, the organisation, and patient care. While
the positive impact of technology suggests that a
system has been successful in achieving its intended
goals, the negative effects should be lessons learned
for future developments. Care should be taken when
designing and implementing such systems to avoid,
or at least minimise, any potentially harmful effects.
Further research is needed to assess the extent of the
effects identified in this study among different user
groups, and in other EDs or hospital departments
with similar characteristics.
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IT IN THE EMERGENCY DEPARTMENT - What is the Impact of Technology?