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MD:Notes - Designing an Information Service for Public Hospitals


The hospital organization, containing a variety of clinical providers and supporting departments, is a complex service delivery system. This system requires a taxonomy of clinical documentation between the different clinicians and services for patient care coordination and billing justification. Our project, MD:Notes (where MD stands for "multiple device") is about the design of a new application for physicians to enter progress notes, one component of all clinical documentation. This paper focuses on the user-centered research conducted at Highland and San Francisco General Hospital around the physicians, the primary stakeholders of the application. Our research demonstrates that a lack of mobility, difficult entry, transcription lag time and a lack of mandate to switch completely over to the electronic format is causing breakdowns that lead to poor service quality. While the design of the application is focused around the physicians, considerations must also be made to the secondary stakeholders, who are concerned with cost, reports for auditing and interoperability. Addressing the goals of all those in the service chain will lead to an application with a higher level of potential adoption.

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