Specifications and needs assessment - The computer in the ward: a study of user needs [1]
1 – Introduction
Management functions of the ward are often designed in the first information systems Hospital (SIH), as inseparable elements of the computer system of centralized architecture hospital. Requirements of medical, diagnostic seizures, exam results are destined to feed central database of the hospital's specialized files for each service, if made, are proposed as extensions of the central database. Examples of this type of architecture are PCS systems provide IBM TDS Technicon, SMS (Shared Medical Systems) or Help. The HFD is used as a means of communication between different units such as medical and administrative tool activity assessment and management control, parallel, especially in institutions with high academic component, developed departmental systems management care unit. These systems are designed to take into account more specific user requirements. Examples of departmental systems are the systems COSTAR (developed at MGH in Boston), TMR (University of Duke), RMS (Regenstrief Medical System) 151, Aida (University of Amsterdam) or those developed with LIED to the Assistance Publique de Paris. Designed as tools for long-term surveillance of patients, support medical decision or to conduct clinical research, they are not always perfectly integrated into the communication network of the hospital. The strategic decision, taken in 1987 by the Assistance Publique de Paris, setting up a network of communication in four of its hospitals (Broussais, Georges Clemenceau, Saint-Louis and Tenon) represented an opportunity for in-depth analysis of the information system of the hospital and conducting an assessment of user demand. This article presents the results of a study in four of the hospital Broussais. It allows one hand to quantify the activity of services and exchanges with various elements of the technical and partly to clarify user requirements in informatics.
2 - Materials and methods
2.1 Selection of wards
Broussais Hospital is a hospital short-stay, mid-sized (700 beds), whose activity is oriented around three main areas: a cardiovascular area, a sector and a nephrologist and immunological digestive sector. Four services do not yet have departmental computing, but to be Computerization of a next, were selected:
• 2 Surgery, General Surgery including an emergency department and surgical intensive care unit.
• 3 Medicine, Cardiology including cardiac intensive care unit and rehabilitation unit.
• 4 Medicine, Pathology Vascular including emergency care unit and rehabilitation unit.
• 6 Medicine, Digestive Diseases including endoscopic unit.
2.2 Assessment of service activity
The description of the services business is based on data submitted by department heads and Supervisors, as well as statistics compiled by the administration. The survey of flow tests further was done from the table of statistics and medical procedures, provided by the office Central cost of the hospital. It is based on the cards billing GAMM (Admin Medical and disease), for different administrative units constituting the services studied, on the full year 1988. In view of our study, we noted that this accounting document only records that additional tests performed by various administrative units (AU) from the hospital to benefit AU of hospitalization but not consultation. Thus, it is not possible, by exploiting these records management, establish the number of laboratory procedures prescribed by the consultations of each service.
2.3 Assessment of user needs
The estimation of user needs was conducted using questionnaires distributed to different categories staff of each service during the period February to April 1988. He was asked to rate, by a score from 0 to 10, a priority in the computerization of each function. These questionnaires were anonymous, only the status of the interviewee being mentioned. They included 27 items covering all functions that can be a computerized list of which is shown in Table 1. This survey was supplemented by the description of existing computer applications for users.
