Computer-based hospital transfusion process: why and how to create the link between continuous quality improvement and clinical information systems?

Within a hospital, the need for a computer-based transfusion system has bec ame mandatory. It facilitates the tracing of healthcare activities, which i s the basis of the security of the care and a functional element of continu ous quality improvement procedures. In order to implement this traceability , reactive and real-time information systems are needed close to healthcare participants, which is not the case of current information systems which r ely on a recorded collection of data, far from the needs of the caregiver, and mainly answering to an objective evaluation of results. In the context of continuous quality improvement programmes started in our hospital, hemov igilance was the first to use a process analysis approach, from the prescri ption of blood units to their administration and follow-up. Several questio ns arise from this: 1) how to use the process analysis work to specify the users' needs of a generalized and real-time transfusion information system? 2) how to spread this model to other healthcare activities? 3) how to inte grate or interface the whole of these quality programmes with a clinical in formation system? A user-centered methodology was used, based on 'usage cas es'. For each step of the transfusion process, this method allowed us to sp ecify participants, data necessary for an activity (observed, deduced or de cision-support data), data issuing from the activity, roles (the interactio n between user and activity) and functions (the result of the interaction b etween user and activity). (C) 2000 Editions scientifiques et medicales Els evier SAS.