Study: Lightweight IT solutions can support heavyweight healthcare information systems

The success of the Medanets implementation project was evaluated in a scientific study focussing on the integration of lightweight and heavyweight IT solutions and the organisational changes they can bring about. Not only did the implementation project meet its predefined objectives, but also had unexpected positive effects on the implementing organisation as a whole. Researchers from the Norwegian Centre for E-health Research presented the results of their study in a webinar¹ in early June.

IT solutions in public healthcare are often large-scale and complex, which makes it hard or even impossible to adapt them to rapidly changing needs. To support these complexities, lightweight IT solutions have been developed in recent years to respond more quickly to changing user needs. With this in mind, the Nordland hospital group (Nordlandssykehuset) implemented the Medanets app between 2020 and 2021 on a large scale. Initially, the main use case for the app was the NEWS process.

The Norwegian Centre for E-Health research got interested in the case, and the organisations agreed to collaborate on a research project aimed to help the hospital team to qualitatively evaluate the implementation. The success of the implementation project was assessed using the scientific NASSS-CAT framework.

“When I talk about it, I can hear that it sounds almost like science fiction“

The main result of the study states that the implementation project was very successful. The researchers find the result surprising, because it contrasts with perceptions and experiences commonly associated with healthcare IT projects. Most nurses using the app were happy with it, and also other participants of the project evaluated the app in an exceptionally positive way. A doctor interviewed in the study said: ‘When I talk about it, I can hear that it sounds almost like science fiction, it was so good.’

Pay attention to digital maturity

Not all the feedback received in the research interviews was positive. Some interviewees described the app as not necessarily time saving in terms of minutes saved for each documentation, although they said it improved the overall workflow². Using a smartphone was also seen as a potential source of misunderstandings with the patients. The researchers concluded that the negative feedback was mainly associated with the low digital maturity of the organisation, the users and the infrastructure needed for using the mobile solution.

Digital maturity refers to the readiness and willingness of an individual or an organisation to utilise digital technology.

The first phases of the project involved a lot of testing and further development of the new technology. Indeed, one of Nordland hospital group’s main objectives was to improve their digital maturity so that it would be easier for them to adopt more lightweight IT solutions in the future.

The implementation project brought about unexpected positive effects

The objectives of improving the NEWS process, reduce paper-based processes and improve the digital maturity of the organisation were achieved. Best of all, the implementation of the app had an immediate positive impact on the day-to-day work of healthcare professionals. Moreover, the implementation of the app had several unexpected, positive effects: it improved the physicians’ workflow, helped department managers to better keep track of the practices and resource needs of the wards, improved multi-professional collaboration and increased the users’ digital competence.

Improvements in physicians’ workloads

Although medical doctors do not use the Medanets app in the Nordland hospitals, the study found that its implementation had many positive effects on their workflows, too. Thanks to the integration between the app and the Electronic Health Record, the physicians now see the patients’ NEWS scores and other clinical data documented with the app in real time – regardless of where in the hospital they are working at that time.

Also, consultations and patient transfers between different wards now go more smoothly, even remotely. In the Electronic Health Record, the data is shown as clear summary views and graphs. The doctors interviewed in the study also say that mistakes in the calculation of NEWS scores, as well as unnecessary phone calls from nurses to doctors, have decreased significantly.

More efficiency in multi-professional communication

Simultaneously, the communication between professional groups and units was improved, because the patients’ statuses now can be discussed using standard terminology and objective parameters. While the patient previously was said to ’seem a bit under the weather’, the professionals can now refer directly to their NEWS scores. Instantly, everyone will know how severe the situation is and what actions will be needed next.

Help for workload optimisation

The Medanets app has been helpful for the work of the department leaders, too. The electric whiteboards on the wards are integrated to the Medanets app and show the patients’ NEWS scores. For instance, this supports resource planning, as the workload can be divided more evenly between the professionals on shift.

Improved digital competencies for the users

Thanks to the improved digital competencies of the users, the nurses can now name new use cases for a mobile solution.

The successful project benefits others as well

The researchers say that the organisation’s digital maturity is crucial to the success of a lightweight IT implementation project. The Nordland hospital group has developed their IT as an ecosystem over many years, always putting the real needs of the users first. The approach has always been to integrate solutions of different providers, each optimised for a specific purpose, to the underlying Electronic Health Record.

Perhaps the most important success factor of this implementation project is the close and extensive cooperation between the different actors. The hospital group’s own IT department listened to the nurses’ suggestions and wishes, assessing their impact on the whole organisation, and coordinating and prioritising their implementation with the solution providers. The flexibility of the Medanets app with its ability to quickly adapt to changing needs was considered particularly important.

Hospitals using the same Electronic Health Record system in Norway can now implement the app in a straightforward manner, as the necessary integration work between the solutions has already been done.