ANALYTIC MEMO ABOUT THE FIELD WORK

AUTHOR:FARAJA MUKAMA

DATE:19TH NOVEMBER 2001

Memo Outline:

Introduction

Exploring the methods used and Reflections on the methods

Thoughts and questions generated for research design - (Theoretical questions and concerns)

What is required to verify or to generalize from qualitative research findings.

INTRODUCTION

Area of interest

My area of interest is the field of Health Information Systems. This is the field where I expect to do my research work. It is a new field to me so I expect to use the knowledge from INF-QUAL, first to get an overview of the field and then to do my research: such as how to conduct interviews and observations as a means of data collection while in the field site.

The field site:

Regarding the field of Health Information Systems, the study was done to the Rikshospitalet – Norway, where by we had an orientation section, observation section and interview section. The main focus in both sections was on the Electronic Patient Record.

A map showing where Rikshospitalet is situatedThe Rikshospitalet building

i.e. north of the center of Oslo, near Ullevål Stadion

  • The orientation section was done by Dr. Invar Berge, who is a doctor at the Rikshospitalet and he also took part in implementing the electronic system for patient’s records.

-The orientation give an overview on the Norwegian Health care System as well as the Rikshospitalet as part of it i.e. where does it fit in the Norwegian Health care System. Also it gave the essence of the Electronic Patient Record as well as the challenges in its use.

-It was conducted in room 218, Forskningsparken II, from 12:30pm to 15:00 on the 16th of October 2001

  • The observation section was done by Per Mathise – MD, who is the Senior Consultant in the Medical Outpatient Department; together with me and my colleagues.

-The observation showed the use of the Electronic Patient Record System in Clinical practice.

-It was conducted at the Rikshospitalet, from 10:00 am to 11:30 am on the 30th of October 2001.

  • During the Interview section Prof. Dr. Med. Albert Paus, who is the head of the Rheumasurgery department was the interviewee and me (Faraja) and Gertrudes were the Interviewers. Pro. Dr. Paus has a three years experience on the use of the Electronic Patient Record.
  • Departments in the Risk hospital (Note: Not all the department are shown)

EXPLORING THE METHODS USED (Findings) and REFLECTIONS ON THE METHODS

Orientation:

The following is a summary of the Orientation section.

  • Norwegian Health care System: Information flow

The Norwegian Healthcare System is divided into five regions, whereby each region has one regional hospital; Rikshospitalet is one of the regional hospitals. Before the regional hospitals there other local hospitals: The structure can be represented by considering a sick person who has to be attended at different levels before going to the regional hospital:

Note: The patient is referred to another level when the particular level can not diagnose him.

  • The essence of the Electronic patient record

The Electronic patient record started in 1995, aiming at reducing the paper record problems such as loss of documents and slow access of information. This can be shown by the following diagram - showing the flow of information from one hospital level to another (paper work at each level transferred to another level):

Paper (very little information, usually lab results) Lacking electronic communication

ComputerizedPapers (letters) e.g. Ex-rays

Papers

  • Challenges in the use of the Electronic Patient record.

There are some challenges that are being faced like, little communication between the departments since not all the departments are not using the system yet.

Before the orientation day, we had prepared questions to be asked during the interview (E.g. how did they come up with the project[1]). On my side the orientation answered most of the questions we had. This was very useful for me as I entered the field (for the observation/interview) having some ideas on what is being done through the use of the Electronic patient record. The most important part of the Orientation is that we were given some practical information (i.e. who to meet, where to meet him, a formal entrance form “Taushetserklæring for Rikshospitalet” to adhere with the rules for visiting the hospital) regarding the Observation/ interviews we were going to conduct at the Rikshospitalet.

Observation:

  • During the observation we were not organized in the sense that we had no prepared questions to ask. I considered the observation we did partly as unstructured interview since everyone was asking questions in a randomly order depending on what he/she wants to know about the use of the Electronic Patient record.
  • However we had an overview on the use of the system[2] by knowing who are the users of the system- receptionists, doctors , nurses and secretaries, the system security- the use of login names, passwords and professional rights[3] , the system design- designed basing on the paper format used before[4] , the system contents(items)- menus for finding patients’ records and advantages of using the system (according to the Per Mathise – MD’s experience), one being the improvement of the quality of his work.

After the observation it was like all the questions I had in mind concerning the Electronic Patient Record were answered, but after discussing with my fellow colleague (member in the interview section), we decided that we would ask the same questions we had prepared for the interview to get different views from different users.

The observation section made me to have the idea of how difficult it is to find someone in the Rikshospitalet; I saw the Rikshospitalet as a large place with a lot of entrances (which are confusing), with almost the same color around. To get familiar to the place I would have to visit (for observation) the place more that one time.

Interview:

  • For the interview we had twelve prepared questions (written), which acted as a guide for the interview. We decided that we will be asking the questions in order; one interviewer after another. While the interview was going on, we (interviewers) were asking some additional questions for the purpose of giving a clear explanation (to the interviewee) at the same time getting a clear explanation (from the interviewee) about the particular written question.
  • The interviewee seemed to be optimistic about the use of the system; concerning our 11th question “What are the anticipated long-term effects of the system on the delivery of medical care?” The interviewee answered that: “the system will provide easier communication within hospitals, between hospitals and between hospitals and primary healthcare. In future each patient will have his/her own case history in the system all the time”.

In my views I think that hospitals will not get rid of paper records, the interviewee when asked about this he suggested that “with strict security, hospitals may get rid of papers sometimes in the future.”

  • I considered the interview as a way of getting a clear understanding on what was not clear during the observations section. This because our observation section consisted of a large number of participants and we were not organized.

THOUGHTS AND QUESTIONS GENERATED FOR RESEARCH DESIGN - (THEORETICAL QUESTIONS AND CONCERNS)

This experience made/makes me think of how I am going to conduct my research during data collection. The main questions I have are:

  • How should I organize the methods (what method should be done first and what should be done last) during my research?
  • Should I include all the methods (orientation, observation and interview) we used?
  • How many how many times should I observe the setting or how may interviewee should I interview to enable me to obtain reasonable information?

My main concern is on getting data from a range of individuals so that I will not be biased on relaying on only one source (individual) of information.

I think organizing the research findings by starting with the orientation section, following the observation section and lastly the interview section is a good way to follow when doing the research: orientation section is necessary for giving a researcher an overview of what the field site is like; for the researcher to gain entrance to the field site. The observation section allows the researcher to be familiar with the field site. The Interview section is useful for providing answers to the researcher’s questions.

WHAT IS REQUIRED TO VERIFY OR TO GENERALIZE FROM QUALITATIVE RESEARCH FINDINGS.

I think it is very difficult to verify or to generalize the information obtained from qualitative research findings.

  • What I am suggesting is that a researcher can verify what he/she has interpreted by gathering feedback about his/her conclusions from participants in the setting studied and from others familiar with the setting (if possible). Also through collecting data from a range of individuals and settings (if there is enough time), can help a researcher no to be biased on only one source of information.

1

[1] Developing an ElectronicPatientRecord

[2]An ElectronicPatientRecord

[3] Each user when logs in a system he/she can access information according to his/her professional rights.

[4] The format on the paper records the hospital is using.