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Open Access Research article

‘You can’t just hit a button’: an ethnographic study of strategies to repurpose data from advanced clinical information systems for clinical process improvement

Cecily Morrison1*, Matthew Jones2, Rachel Jones3 and Alain Vuylsteke4

Author Affiliations

1 Engineering Design Centre, University of Cambridge, Cambridge, CB2 1PZ, UK

2 Judge Business School, University of Cambridge, Cambridge, CB2 1AG, UK

3 Instrata Limited, 12 Warkworth Street, Cambridge, CB1 1EG, UK

4 Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE, UK

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BMC Medicine 2013, 11:103  doi:10.1186/1741-7015-11-103

Published: 10 April 2013



Current policies encourage healthcare institutions to acquire clinical information systems (CIS) so that captured data can be used for secondary purposes, including clinical process improvement. Such policies do not account for the extra work required to repurpose data for uses other than direct clinical care, making their implementation problematic. This paper aims to analyze the strategies employed by clinical units to use data effectively for both direct clinical care and clinical process improvement.


Ethnographic methods were employed. A total of 54 contextual interviews with health professionals spanning various disciplines and 18 hours of observation were carried out in 5 intensive care units in England using an advanced CIS. Case studies of how the extra work was achieved in each unit were derived from the data and then compared.


We found that extra work is required to repurpose CIS data for clinical process improvement. Health professionals must enter data not required for clinical care and manipulation of this data into a machine-readable form is often necessary. Ambiguity over who should be responsible for this extra work hindered CIS data usage for clinical process improvement. We describe 11 strategies employed by units to accommodate this extra work, distributing it across roles. Seven of these motivated data entry by health professionals and four addressed the machine readability of data. Many of the strategies relied heavily on the skill and leadership of local clinical customizers.


To realize the expected clinical process improvements by the use of CIS data, clinical leaders and policy makers need to recognize and support the redistribution of the extra work that is involved in data repurposing. Adequate time, funding, and appropriate motivation are needed to enable units to acquire and deliver the necessary skills in CIS customization.

Clinical information system; Clinical process improvement; Computerized medical records systems; Intensive care; Qualitative research; Secondary use of data; User-customization