Bringing service design to the development of health information systems: The case of the Portuguese national electronic health record

Abstract

Background: Health Information Systems (HIS), and especially Electronic Health Records (EHR), offer great promise. However, the true benefits of HIS and EHR are more elusive as research shows they have obtained mixed results across countries. To increase the success of these systems while creating value for healthcare professionals, research emphasizes the importance of involving clinical users in the design of HIS.

Objective: Following calls for interdisciplinary research and increased end-user participation in HIS development, this paper shows how a service design approach can support the successful development and implementation of national EHRs. Service design brings a human-centered, participatory, holistic, creative and visual approach to HIS development, through an iterative process of exploration, ideation, reflection and implementation, fostering stakeholder participation and co-creation of the solution.

Method: This paper presents an in-depth case study of the Portuguese National EHR development and implementation following a service design approach. The study involved individual and group interviews, as well as participatory design workshops with more than 170 participants along the different stages of exploration, ideation, reflection and implementation.

Results: The service design approach, including the visual models and tools used across the different design stages, was instrumental to envision new EHR concepts and design the system to enhance healthcare users experience. A qualitative study performed after implementation showed that the EHR was considered useful and easy to use, and these results are backed by widespread usage of the system.

Discussion and conclusion: This paper shows how a service design approach can address key challenges in EHR development. By adopting a holistic perspective, service design broadens the scope of EHR development to understand its broader service system and position it to enable value creation with users. The human-centered, participatory, creative, visual and holistic approach supports the understanding of user needs and context, and their active involvement in the design and co-creation effort. This service design approach fosters user adoption at the implementation stage. Service design can thus contribute to the successful development and implementation of EHRs.

Keywords: Case Study; Electronic Health Records; Health Information Systems; Portuguese EHR; Service Design.