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We found no significant change in the accuracy of clinicians' reading of skeletal radiographs before and after PACS- introduction. The level of inter-rater agreement between clinicians and radiologists was high in both periods, but they disagreed in significantly more cases after PACS.

Objective: A teaching hospital in the Netherlands has developed a Nursing Information System (NIS). After the NIS was implemented in six wards in March 2009, the NIS was evaluated. Since micro-relevance is a key-factor in adoption of Information Systems, the objective of this study is to reveal which aspects of the NIS are micro-relevant to nurses. Methods: A paper questionnaire was distributed among all 195 nurses, who used the system. Included in the research were 93 (47.7%) respondents. Also six NIS-users were interviewed, using the USE IT-model. Results: Nurses mainly used those functions of the NIS, which were essential for reporting or retrieving patient information. The NIS was appreciated for supplying unhampered access to complete, legible, structured patient data. Conclusions: For nurses the NIS is a good substitute for the paper record. The micro-relevance of other functionality than supplying information seems to be low.

Akershus University Hospital introduced Information and Communication Techno-logy (ICT) to its radiology department in 2005. Both images and reports were stored and communicated electronically instead of as printed film and paper. The images and reports were also made available to clinicians directly from the Electronic Patient Record (EPR). The objective of this study was to retrospectively assess whether the introduction of ICT improved diagnostic imaging and health care. The objective was addressed by investigating whether the introduction of ICT made radiology reports available sooner to clinicians, whether they read them sooner, whether this had an impact on the length of patient hospital stay, and whether any improvement in reporting was achieved without reducing the diagnostic accuracy. The basic design of this study was a before-after study using two cross-sectional data collections. The establishment of hypotheses was in part assisted by a data splitting method. Most analyses were based on data retrieved retrospectively from the hospital infor-mation systems; the Radiology Information System (RIS), The Picture Archiving and Communication System (PACS) and the EPR. These data were partly recorded by health care professionals as part of their daily work, and partly created by automatic logging of their activities. Person-identifiable attributes were removed for both pa-tients and health care professionals before the statistical analysis. Supplementary data was collected manually from work lists and routine descriptions. Diagnostic accuracy was addressed by comparing a retrospective classification of lesions reported in the original reports with lesions identified in an independent re-analysis of the images. The data were analysed using the two-sided non-parametric Mann-Whitney U-test for ordinal and the T- test for nominal data. The median report turnaround time (RTAT) – the time from the images were acquired until they were reported - was initially reduced by 84% for the preliminary version and by 44% for the final version of the reports. Over the observation period, the me-dian RTAT increased slightly for preliminary reports, and was reversed almost back to the pre-ICT level for final reports. However, the percentage of preliminary reports available for the clinical afternoon round increased over the observation period. Radi-ologists used the flexibility of the system to give priority to preliminary ultrasound (US) and all Computed Tomography (CT) reports. Both preliminary and final reports were immediately sent to the EPR. The median time until the final reports were opened by a clinician was 2.8 to 3.9 hours. The use of final reports did not vary much over the observation period. In total, 88% of the final reports had been opened 4 weeks after they became available in the EPR. For prelimi-nary reports, the median time until they were opened was 40 to 50 minutes. Only 42% of them were read. Preliminary CT and US reports were opened sooner than CR re-ports. There was no general reduction in length of patient hospital stay (LOS) after the ICT introduction. There was, however, a reduction in LOS for patients with one or more CT scans, from 5.3 to 3.9 days. This reduction was significant both in itself and rela-tive to the non-CT group. It has been feared that more lesions would be missed than when images were printed on film. Our study did not identify any such deterioration. On the contrary, when both certain and uncertain findings were included, the detection sensitivity was actually improved. The introduction of ICT led to reports being available for and read by clinicians earli-er than before, however not all effects proved sustainable. We also found that radiolo-gists used the flexibility offered by the system to give priority to certain report catego-ries. The study indicated that length of stay was reduced for patients that had CT scans during their stay. Diagnostic sensitivity of chest radiographs did not deteriorate. Our findings indicate that when ICT is introduced in the radiology department of a large hospital, a few improvements may follow. However, our findings also indicate that an ICT introduction may have an untapped potential, and that not all effects are neces-sarily sustained. We did not observe important adverse consequences of the ICT in-troduction.