Use Of Clinical Information Systems Research Articles

Review on Radiation Therapy Information Systems

Aim: Clinical and pre-clinical radiotherapy data represent one of the most valuable assets for radiation therapy and oncology institutions. The present study aimed to review various clinical information systems used in the field of radiotherapy and the critical success factors influencing the system implementation.
 Method: This review study was completed in 2022. In this study, papers related to clinical information systems in the field of oncology were retrieved by using keywords. The databases and the search engine were Scopus, PubMed, Science Direct, Web of Knowledge, Ovid, Medline, and Google Scholar and the time frame was between 2010 and 2022. Initially, a total of 427 papers were retrieved, and finally, 18 related papers were selected.
 Results: The main clinical information systems used in radiotherapy included developing a patient’s electronic chart checks (two studies), establishing a web-based Integrated Radiation Oncology Information Platform, implementing a web-based Electronic Data Capture system, developing a data archiving system, developing a prototype software for the anonymization of radiation therapy treatment plans, creating a national radiation oncology registry, identifying deficiencies in treatment plans and radiotherapy simulation, creating a web-based radiotherapy system and other related studies (nine studies).
 Conclusion: The use of clinical information systems in the field of radiotherapy is inevitable, mainly due to the wide range of benefits that these systems have. However, to implement these systems successfully, proper choice of technology, user training, application of standards, use of big data, periodic evaluations, as well as workflow identification are required for effective use of these systems.

Collaborative chronic care model implementation within outpatient behavioral health care teams: qualitative results from a multisite trial using implementation facilitation

BackgroundThis paper reports on a qualitative evaluation of a hybrid type II stepped-wedge, cluster randomized trial using implementation facilitation to implement team-based care in the form of the collaborative chronic care model (CCM) in interdisciplinary outpatient mental health teams. The objective of this analysis is to compare the alignment of sites’ clinical processes with the CCM elements at baseline (time 1) and after 12 months of implementation facilitation (time 2) from the perspective of providers.MethodsWe conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at times 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at times 1 and 2.ResultsWe conducted 27 and 31 telephone interviews at times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At time 1 and time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from time 1 to time 2 were work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at time 2 compared to time 1, while others had reductions. For the provider decision support element, we saw little change in the extent of its implementation.ConclusionsSites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes in place at time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources.Trial registrationClinical Trials NCT02543840.

Low-Intensity Intervention Supports Diabetes Registry Implementation: A Cluster-Randomized Trial in the Ambulatory Care Outcomes Research Network (ACORN).

Previous research demonstrated that registries are effective for improving clinical guideline adherence for the care of patients with type 2 diabetes. However, registry implementation has typically relied on intensive support (such as practice facilitators) for practice change and care improvement. To determine whether a remotely delivered, low-intensity organizational change intervention supports implementation and use of diabetes registries in primary care. Cluster-randomized controlled effectiveness trial of providing limited external support leveraging internal practice resources and problem-solving capacities for driving diabetes registry implementation in 32 practices in Virginia. All practices identified local implementation champions who participated in an in-person education session on the value and use of diabetes registries, while intervention practices were also paired with peer mentors and had access to a physician informaticist, who worked remotely to assist practices with implementation. Practice champions reported progress on registry implementation milestone achievement, and reported practice-level organizational capacity by using a modified version of the Assessment of Chronic Illness Care (ACIC). Intervention practices were significantly more likely to have implemented a registry (44% vs 6%, P = .04) and to have achieved more implementation milestones (5.5 vs 2.6, P < .0001) than control practices. Baseline ACIC scores indicated room for organizational improvement with regard to chronic illness care (overall median, 6.4; range, 3.8 to 10.8) and clinical information systems use (median, 6.0; range, 0 to 11) with no significant differences between intervention and control practices. Remotely provided guidance paired with limited in-person assistance can support rapid implementation of diabetes registries in typical primary care practices.

Implementation and evaluation of an electronic minimum dataset for nursing team leader handover in the intensive care: An interventional study

Introduction: Miscommunication during handover has been linked to adverse patient events and is an international priority. There is widespread use of clinical information systems in intensive care units (ICU) however, evidence-based electronic handover tools are limited.

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey

IntroductionThere is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. ObjectivesThe study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. MethodsThe study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from ‘strongly disagree’ to ‘strongly agree’, and open-ended questions. Descriptive statistics were used to summarise results. Results and discussionA total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. ConclusionBarriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders’ adoption of a minimum dataset for handover.

Statewide Study to Assess Nurses' Experiences With Meaningful Use-Based Electronic Health Records.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

Clinical Information Systems - From Yesterday to Tomorrow.

To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author's personal experience with developing the HELP system were also used. There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.

System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy. The findings identify areas of focus for development of barrier-driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health center performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.

Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography

ObjectiveThis study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICUs) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician's rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices. The US Department of Veterans Affairs (VA) Office of the Chief of Nursing Informatics sought to understand usage barriers and facilitators to optimize these systems in the future. Therefore, a human factors study was carried out to observe the CIS and ARK systems in use at three VAMCs in order to identify best practices and suggested improvements to currently implemented CIS and ARK systems. MethodsWe conducted a rapid ethnographic study of clinical end-users interacting with the CIS and ARK systems in the critical care and anesthesia care areas in each of three geographically distributed VAMCs. Two observers recorded interactions and/or interview responses from 88 CIS and ARK end-users. We coded and sorted into logical categories field notes from 69 shadowed participants. The team transcribed and combined data from key informant interviews with 19 additional participants with the observation data. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, which translated directly to barriers to effective adoption and optimization of the CIS and ARK systems. ResultsEffective optimization of the CIS and ARK systems was impeded by: (1) integration issues with other software systems; (2) poor usability; (3) software challenges; (4) hardware challenges; (5) training concerns; (6) unclear roles and lack of coordination among stakeholders; and (7) insufficient technical support. Many of these barriers are multi-faceted and have associated sub-barriers, which are described in detail along with relevant quotes from participants. In addition, regionalized purchases of different CIS and ARK systems, as opposed to enterprise level purchases, contributed to some of the identified barriers. Facilitators to system use included (1) automation and (2) a dedicated facility-level CIS-ARK Coordinator. ConclusionsWe identified barriers that explain some of the challenges with the optimization of the CIS and ARK commercial systems across the Veterans Health Administration (VHA). To help address these barriers, and evolve them into facilitators, we categorized report findings as (1) interface and system-level changes that vendors or VA healthcare systems can implement; (2) implementation factors under VA control and not under VA control; and (3) factors that may be used to inform future application purchases. We outline several recommendations for improved adoption of CIS and ARK systems and further recommend that human factors engineering and usability requirements become an integral part of VA health information technology (HIT) application procurement, customization, and implementation in order to help eliminate or mitigate some of the barriers of use identified in this study. Human factors engineering methods can be utilized to apply a user-centered approach to application requirements specification, application evaluation, system integration, and application implementation.

What components of chronic care organisation relate to better primary care for coronary heart disease patients? An observational study

ObjectivesCardiovascular risk management (CVRM) received by patients shows large variation across countries. In this study we explored the aspects of primary care organisation associated with key components of CVRM in...

Provider and Systems Factors in Diabetes Quality of Care

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Structured terminologies in clinical information systems: implementation through collaboration.

The structure and content of the dialog with a clinical end-user is a critical aspect of clinical information system use, data capture and retrieval, and efficient and effective health care. This dialog is driven ultimately by embedded structures and processes that: a) provide functional models of clinical expression in support of professional practice, and b) determine how structured terminologies ought to populate these models. Based on diverse practical experience, this study identifies challenges to implementing structured clinical terminologies, categorizing them by both stakeholder group and application area. Collaboration across all stakeholders and across a wide range of application areas is identified as a key ingredient to successful terminology implementation and use.

Review of Reported Clinical Information System Adverse Events in US Food and Drug Administration Databases

BACKGROUND: The US FDA has been collecting information on medical devices involved in significant adverse advents since 1984. These reports have been used by researchers to advise clinicians on potential risks and complications of using these devices. OBJECTIVE: Research adverse events related to the use of Clinical Information Systems (CIS) as reported in FDA databases. METHODS: Three large, national, adverse event medical device databases were examined for reports pertaining to CIS. RESULTS: One hundred and twenty unique reports (from over 1.4 million reports) were found, representing 32 manufacturers. The manifestations of these adverse events included: missing or incorrect data, data displayed for the wrong patient, chaos during system downtime and system unavailable for use. Analysis of these reports illustrated events associated with system design, implementation, use, and support. CONCLUSION: The identified causes can be used by manufacturers to improve their products and by clinical facilities and providers to adjust their workflow and implementation processes appropriately. The small number of reports found indicates a need to raise awareness regarding publicly available tools for documenting problems with CIS and for additional reporting and dialog between manufacturers, organizations, and users.

Factors influencing the use of IT in the emergency department: A qualitative study

Investigating factors influencing the use of clinical information systems can help to develop a strategy to improve user acceptance of a given system or similar ones in the future. In this research, we investigated factors influencing the use of information technology in the emergency department (ED). We undertook a qualitative study in which data were collected using semi-structured interviews with the ED staff. In total, 34 interviews were conducted and data were analysed using framework analysis. The results showed that user characteristics and perception of task, technology, environment, and impact of technology could influence people's use of IT in the ED. Of these, the usefulness of the systems, the impact of technology, IT training, and the feasibility of using IT by all members of staff seemed to be the main concerns. Addressing these factors in designing and implementing a system could help to introduce the change successfully and improve the acceptance of information technology.

Stratifying Computer Literacy

Institutions using a clinical information system which feeds an electronic medical record system must consider evaluation programs that measure the nurse's ability to use and understand the clinical data in the clinical information system. By measuring and tracking the nurse's level of computer literacy, training programs and system enhancements can be better designed. A well-designed system will lead to improved system acceptance and higher adoption rates. There is a need for a defined system implementation strategy that includes nursing staff assessment and system training formulated to fit the specific literacy levels of the majority users of the clinical information system, the nursing staff. Computer literacy in relation to the use of clinical information systems and electronic medical record adoption is the focus of this article. If a strategy based on Benner's novice to expert theory is implemented, computer literacy among frontline users could be assessed, and appropriate education and training programs can be developed. Ultimately, these programs would promote positive perception of the clinical information system, which would result in a better adoption rate of the electronic medical record.

Survey of clinical information system usage by paediatric intensive care units in the UK

Dear Editor, The use of clinical information systems (CIS) and electronic prescribing have been shown in single centre studies to improve access to vital data, enhance patient safety and reduce manual documentation time in critical care [1, 2]. There are few large-scale reports of CIS utilisation in paediatric intensive care units (PICU). As part of the Informatics subgroup of the UK Paediatric Intensive Care Society, we conducted a national survey to study the distribution, characteristics and satisfaction with existing electronic systems. Lead intensivists, nurses and/or data managers from the Paediatric Intensive Care Audit Network (PICANet) [3] were invited to complete a self-administered questionnaire survey in September 2007, either online (QuestionPro, http://www. questionpro.com), on an emailed portable document format (PDF) form or on paper. Questions focused on: (a) use of hospital-wide electronic systems; (b) clinical functionality available in PICU systems; (c) data security; (d) research and audit; (e) user satisfaction measured on a Likert scale (1, very satisfied; 5, very dissatisfied); and (f) future plans for CIS implementation. Data were analysed at the unit level, except satisfaction scores, which were analysed at the respondent level. Characteristics of participating units (admission numbers, number of beds and unit type) were obtained from PICANet. Group-wise differences were analysed by using the chi-square test; Wilcoxon sign rank test was used for satisfaction scores. Fifty respondents from 28 out of 32 UK PICUs completed the survey (response rate 88%). Intensivists and nurses comprised the majority of subjects (62%). One-third of the units admitted more than 500 patients/ year, the majority being combined medical-surgical units. More than 80% of the units used hospital-wide systems for patient admission/discharge, radiology and laboratory results. In addition, units used a mixture of small locally developed (16/28) and commercial databases (8/28) with widely varying clinical functionality. Only one unit had gone ‘‘paperless’’ by implementing an integrated CIS with charting, clinical documentation and prescribing functions. In general, larger units were more likely to adopt more functional, commercial systems rather than ‘‘home-grown’’ databases (p \ 0.05). Clinical functionality provided by the various PICU systems is summarised in Table 1. In addition to clinical systems, a number of separate research and audit databases were also used to store data on specific patient groups (e.g. sepsis or extracorporeal membrane oxygenation) resulting in significant duplication of data entry and storage. No significant differences were seen between satisfaction levels of doctors and nurses, although ‘‘home-grown’’, less functional systems scored marginally higher satisfaction levels than commercially procured systems (median 2.5 vs. 2.0). Nevertheless, 5 PICUs reported plans to procure fully functional CIS within a year of the survey. Our study demonstrates poor uptake of CIS in UK PICUs, with larger units more likely to invest in clinical systems and smaller units

Capturing Nursing Care Workflow Disruptions

Clinical information systems implementation in healthcare delivery has changed clinical work patterns. Nursing practice is under pressure of the changes, which often lead to dysfunctional workflow. The purposes for this literature review were (1) to identify what has been examined about disruptions of nursing care workflow in using Clinical information systems and (2) to obtain a lesson for future research to investigate disruptions of nursing care workflow in using Clinical information systems. In reviewed studies, nursing workflow disruptions have limitedly been reported. Nursing care workflow has not been investigated sufficiently; thus, what happened to nursing care workflow by using a Clinical information system has not been fully known. Nurses have a need for the use of a Clinical information system in aspects of nursing perspective in patient care. Unless the use of Clinical information systems provides effective workflow of nursing care, it will result in confusion in nursing practice as well as poor quality of patient care. It is essential to capture disruptions and/or effectiveness in nursing care workflow from the perspectives of nurses. The required research approach to clinical settings is to identify all facets of adverse consequences triggered from the use of a Clinical information system by following the context of nursing care workflow.

Are specialist physicians missing out on the e‐Health boat?

Nationally health systems are making increasing investments in the use of clinical information systems. Little is known about current computer use by specialist physicians, particularly outside the hospital setting. To identify the extent and reasons physician Fellows of the Royal Australasian College of Physicians (RACP) use computers in their work. A self-administered survey was emailed from the RACP to all practising physicians in 2007 that were living in Australia and New Zealand who had consented to email contact with the College. The survey was sent to a total of 7445 eligible physicians, 2328 physicians responded (31.3% response rate), but only 1266 responses (21.0%) were able to be analysed. Most 97.5% had access to computers at work and 96.5% used home computers for work purposes. Physicians in public hospitals (72.6%) were more likely to use computers for work (65.6%) than those in private hospitals (12.6%) or consulting rooms (27.3%). Overall physicians working in public hospitals used a wider range of applications with 70.5% using their computers for searching the internet, 53.7% for receiving results and 52.7% used their computers to engage in specific educational activities. Physicians working from their consulting rooms (33.6%) were more likely to use electronic prescribing (11%) compared with physicians working in public hospitals (5.7%). Fellows have not incorporated computers into their consulting rooms over which they have control. This is in contrast to general practitioners who have embraced computers after the provision of various incentives. The rate of use of computers by physicians for electronic prescribing in consulting rooms (11%) is very low in comparison with general practitioners (98%). One reason may be that physicians work in multiple locations whereas general practitioners are more likely to work from one location.

Benchmarking Electronic Medical Records Initiatives in the US: a Conceptual Model

This article provides a conceptual model for benchmarking the use of clinical information systems within healthcare organizations. Additionally, it addresses the benefits of clinical information systems which include the reduction of errors, improvement in clinical decision-making and real time access to patient information. The literature suggests that clinical information systems provide financial benefits due to cost-savings from improved efficiency and reduction of errors. As a result, healthcare organizations should adopt such clinical information systems to improve quality of care and stay competitive in the marketplace. Our research clearly documents the increased adoption of electronic medical records in U.S. hospitals from 2005 to 2007. This is important because the electronic medical record provides an opportunity for integration of patient information and improvements in efficiency and quality of care across a wide range of patient populations. This was supported by recent federal initiatives such as the establishment of the Office of the National Coordinator of Health Information Technology (ONCHIT) to create an interoperable health information infrastructure. Potential barriers to the implementation of health information technology include cost, a lack of financial incentives for providers, and a need for interoperable systems. As a result, future government involvement and leadership may serve to accelerate widespread adoption of interoperable clinical information systems.

The Importance of Medical and Nursing Sub-cultures in the Implementation of Clinical Information Systems

To measure doctors' and nurses' perceptions of organisational culture and relate this to their attitudes to, and satisfaction with, a hospital-wide mandatory computerised provider order entry (CPOE) system in order to illuminate cultural compositions in CPOE use. A cross-sectional survey design was employed. Data were collected by administering an organisational culture survey (Organisational Culture Inventory, OCI) along with a user-satisfaction survey to a population of 103 doctors and nurses from two clinical units in an Australian metropolitan teaching hospital. Clinicians from the hospital had used the CPOE system since 1991 to order and view clinical laboratory and radiology tests electronically for all patients. The OCI provides a measure of culture in terms of three general styles which distinguish between: constructive; passive/defensive, and aggressive/defensive cultures. The cluster which best describes the overall culture is the one that has the highest percentile score when the percentile scores of the four cultural norms included in the cluster are averaged. The user satisfaction survey asked questions relating to satisfaction with, and attitudes to, the system. We found identifiable sub-cultures based on professional divisions where doctors perceived an aggressive-defensive culture (mean percentile score = 43.8) while nurses perceived a constructive culture (mean percentile score = 61.5). There were significant differences between doctors and nurses on three of the attitude variables with nurses expressing more positive views towards CPOE than doctors. The manifestation of sub-cultures within hospitals and the impact this has on attitudes towards clinical information systems should be recognized and addressed when planning for system implementation. Identification and management of the cultural characteristics of different groups of health professionals may facilitate the successful implementation and use of clinical information systems.