OBJECTIVES:Due to the high complexity of structures and processes in health care, thorough systems analyses in health care run the risk of becoming very complex and difficult to handle. Therefore, we aimed to support systematic systems analysis in health care by developing a comprehensive framework that presents and describes potential areas of analysis. METHODS:A framework for systems analysis in health care was developed and applied in a health care setting. To provide a clear structure, the framework describes the potential views and levels of systems analyses in a health care environment. RESULTS:The framework comprises five views (roles and responsibilities, information processing and tools, communication, business processes, teams structure and cooperation) and five levels of analysis (overall organization, organizational unit, staff member, role, task). The framework was successfully applied in an analysis of the structures and processes of the Department of Child and Adolescent Psychiatry of the University Medical Center Heidelberg. CONCLUSIONS:The proposed comprehensive framework aims to structure the views and levels of systems analysis in the complex health care environment. Our first experiences support the usefulness of such a framework.

A two-month randomized, controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center, Germany, to investigate the influence of computer-based nursing documentation on time investment for documentation, quality of documentation and user acceptance. Time measurements, questionnaires, documentation analysis and interviews were used to compare patients documented with the computer-based system (PIK group) with the control group (patients documented with the paper-based system). The results showed the advantages and disadvantages of computer-based nursing documentation. Time needed for nursing care planning was lower in the PIK group. Some formal aspects of quality were considerably better in the PIK group. On the other hand, time required for documentation of tasks and for report writing was greater in the PIK group. User acceptance increased significantly during the study. The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians.

This paper presents first results of a research project aimed at improving co-operative work initiatives in hospitals. A holistic analysis of the treatment process is presented as a precondition for process reengineering, quality measurements and improvement of multi-professional co-operation. Treatment process modelling attempts within the last years have concentrated on specialised points of views, such as business process modelling or communication modelling. In contrast, we have developed a framework consisting of several views of the treatment process. We tested our framework in a broad system analysis within the Department of Child and Adolescent Psychiatry of the Heidelberg University Hospitals. Our preliminary results support the framework. Weaknesses were described precisely in both the field of organisational procedures and information management.

The documentation of the nursing process is one important part of the clinical documentation. The nursing process provides a systematic methodology for nursing practice. It consists of six phases: 1. Assessment of relevant information; 2. Definition of problems and resources of the patient; 3. Derivation of nursing aims, 4. Planning of the nursing tasks; 5. Execution of these tasks; 6. Evaluation of nursing care. In Germany, paper-based systems have been introduced to support nursing process documentation, but there are frequent reports of high expenses for the documentation, of low quality and of limited user acceptance [1]. It is unclear if computer-based documentation systems can solve these problems. There have been a few studies evaluating the effects of computer-based nursing process documentation [2, 3], but none of them used a controlled study design which allows a direct comparison between paper-based and computer-based nursing process documentation. Therefore, we decided to conduct such a controlled randomised study at the Department of Psychiatry at the Heidelberg University Hospital to compare the old paper-based documentation system (based on forms with mainly free-text entry) to a new computer-based application system.

We would like to introduce several aspects of the analysis and modeling of the treatment process characterizing the cooperation within multi-professional treatment teams. We will determine what is meant by a treatment process in order to then look at five views and four levels of their description. We will introduce possible methods for surveying and describing it. Currently an extensive analysis of the current state of the treatment process and of the weaknesses is underway in the Department of Child and Adolescent Psychiatry of the Heidelberg University Medical Center.

To evaluate the idea of a multifunctional mobile pen computer to support information processing tasks of health care professionals we carried out a field study. On a tablet-sized mobile pen computer we set up a health professional workstation, MEDIAS/WIN, with most of the application systems that are presently used by health professionals at Heidelberg University Medical Center. Our experiences during the study, involving 11 physicians, nine nurses and four computer scientists showed that it's not enough to make existing applications mobile most user interfaces have to be adapted for pen input. The presented system served as a valuable basis for study purposes but was not suitable for use in clinical routine. Patient data of the current clinical case and medical knowledge in the form of reference lists were found to be most important for mobile usage. Desirable functionality also included mobile access to electronic mail, electronic ordering of meals and some documentation tasks, e.g. the documentation of diagnoses and orders for diagnostic and therapy.