차세대 전자간호기록 시스템 유스케이스 개발: 업무흐름 분석과 전문가 델파이 기법 적용
Use Case Development for Next Generation Electronic Nursing Record Systems Utilizing Clinical Workflow Analysis and a Delphi Survey
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연구목적: 본 연구는 간호사가 간호기록을 효율적으로, 오류 없이, 만족스럽게 수행할 수 있도록 사용성이 향상된 전자간호기록(ENR) 시스템 개발과 관련한 사용자 요구사항 규명을 위해 수행되었다. 연구방법: 본 연구는 혼합연구 설계로 간호업무 내용과 업무흐름 패턴 분석, 시스템 사용성과 ENR에 대한 문헌고찰이 이루어졌으며, 이를 기초로 추상적 단계의 유스케이스 도출과 타당도 조사가 이루어졌다. 업무내용과 업무흐름 패턴 분석은 6개 종합병원에서 타임모션 방법으로 내외과, 중환자실에서 무작위 층화표출 한 간호활동 로그 샘플 중 무작위 추출된 21회 근무조 데이터였다. 문헌고찰은 간호계, 의료정보학 분야 학회와 협회, 국립표준원에서 개발한 원칙, 지침, 권고사항, 가이드라인 중심으로 이루어졌다. 유스케이스 타당도는 8명의 실무 전문가 패널과 2명의 학계 전문가 패널이 참여한 델파이 조사를 통해 각 유스케이스별, 상세 항목별 중요도(5점 Liker scale)와 수렴도로 측정되었다. 연구결과: 업무분석과 문헌고찰로부터 최종 9개 유스케이스와 상세 내용이 도출되었으며, 4회 데파이 조사 과정을 유스케이스와 항목 내용이 정련되었다. 최종 확정된 유스케이스와 항목에 대해 중요도는 4점 이상이었으며, 수렴도는50 ~ 70%이상을 보였다. 결론: 전자간호기록 시스템 요구사항으로 도출된 9개 유스케이스는 사용성 향상을 위해 기존 시스템 개선과 차세대 시스템 개발에 필수적으로 고려되어야 할 내용이다
Abstract
Purpose: To identify user requirements for electronic nursing record (ENR) systems so as to ensure system usability. Methods: A mixed methods approach were applied in three steps : (i) task and workflow analysis with literature review of nursing documentation, (ii) literature reviews of system usability, and (iii) Use Case idenfication and consensus-based validation. We analyzed the nursing activity logs collected from a time-motion investigation of six hospitals. The Use Cases were validated by eight clinical experts from different hospitals and two experts from academia in a sequential Delphi survey. Consensus was achieved for the significance score and agreement among the panel. Results: Eight task groups and patterns of task flow were observed, which were translated into nine Use Cases. The specification of Use Cases was derived from principles, guidelines, and recommendations on nursing documentation and electronic health record systems, which was organized into three requirements of each Use Case: functionality, information, and design characteristics. Each Use Case achieved an agreement of 50~70%, and significance scores of 4 or 5 on a 5-point Likert scale. Conclusion: The nine Use Case identified were considered to be important and adequate in terms of both clinical and informatics contexts.
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