af Klercker T et al. 1998 "Dilemmas in introducing world wide web-based information technology in primary care: a focus group study."

af Klercker T, Zetraeus S. Dilemmas in introducing world wide web-based information technology in primary care: a focus group study. Fam Pract 1998;15(3):205-210.
"Background: When implementing a computer-based decision support system for any disease group in a primary health care centre, success will depend on the introductory efforts put into the project. The users must have plenty of information, above all regarding what can and what cannot be done by the computer-based decision support system. A personal introduction including a personal instruction session in front of the computer is imperative. Different aspects of technical maturity of the system must be met. Communication within and outside of the local net must be stable. Methods: Using a designated focus group methodology, we studied the introduction of advanced information technology in primary care by applying an inter/intranet decision support system for ambulatory ear, nose and throat diagnostics using a World Wide Web tool at the Skanninge health centre in Ostergotland, Sweden. Conclusions: A computer-based decision support system of the kind studied here may after a refinement period have all the qualities asked for by the users, and this study can be used as part of a user-developer dialogue for a future system."

"To assess how the introduction of new technology is accepted and what means are available to influence this, and whether there are recognizable stages and factors in the process that might in turn, be modified ... The specific aim was to use and evaluate a case-based computerization decision support system (CDSS) using WWW [world wide web] tools and utilizing the internet in an ordinary Swedish [primary health care] centre."

Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Small and/or medium
Other Information
The study was conducted in the Skanninge primary care center in Ostergotland, Sweden. The center has a staff of 21: five physicians (mostly family medicine specialists), seven trained nurses specializing in community work, four nurses' aides, one physiotherapist, one occupational therapist, one lab technician, and two administrative staff. Skanninge has a population of 5,800.
Type of Health IT
Decision support system
Type of Health IT Functions
The case files of 2,500 patients "were used to create a decision tree for ear, nose and throat (ENT) diseases." The tree was used to create a computerized decision support system primarily for the use of nurses in phone consultations.
Context or other IT in place
An electronic medical record system (EMR) was already in place. The decision support system was not integrated with the EMR system.
Workflow-Related Findings
Nurses did not like the fact that the system could only focus on one symptom at a time.
"One has to use the same words for the same thing all the time and in all instances." "Everybody that had used the CDSS wondered about some of the terms used in the program."
The fact that the CDSS was not integrated with the EMRS "led to entering the data twice."
The CDSS "was easy to use but at too basic a level." The nurses' own knowledge made it unnecessary, or even irritating, for them to use it as diagnostic support.
Study Design
Only postintervention (no control group)
Study Participants
Each focus group had the same five members: one nurse's aide, three trained nurses, and one physician.