In recent decades, South-Eastern Norway Regional Health Authority has introduced several shared electronic records solutions intended to provide improvements in the health service (1, 2). The hospitals in the region use three different records systems to prescribe medication linked to obstetrics: the main records in DIPS, birth records in Partus and the electronic patient chart in MetaVision. Health workers who want to know what medications the patient is using or want to find active prescriptions and dispensed drugs must open all three programs to obtain complete information. Moreover, information on medication use frequently needs to be updated in some of the systems.
The starting point for our work was that the electronic patient journal and medication solution did not communicate perfectly with the other solutions. We therefore wanted to work on further improvements. In our experience, such improvement can best be achieved using a so-called process-based approach (3). A process includes 'everything related to a specific matter', meaning activities, the people involved, any digital solutions and other information systems (4). A process-based approach describes how different tasks are addressed, either in sequence or in parallel. Processes followed in an enterprise are frequently undocumented, but exist as inherent procedures (5).
A process-oriented approach to the introduction work will help identify and eliminate undesired effects before they arise
Introducing a solution to improve specific parts of a process will have consequences for other systems and processes in the organisation. This reduces the totality of the improvement, and may inadvertently reduce the overall benefits and gains. The reason is that organisations and processes have interrelations or value chains that are not described anywhere (6). New measures, such as introducing a new records solution, may have inappropriate consequences unless dependencies within the organisation are taken into account prior to the introduction. In addition, the records system may be designed according to premises that for various reasons do not work in clinical practice, and a well-established workflow may need to be changed as a result. A process-oriented approach to the introduction will help identify and eliminate undesired effects before they arise (7).