Healthcare professionals as customers: A service perspective on Portuguese primary care health information systems Jorge Grenha Teixeira Faculty of Engineering, University of Porto Portugal jorge.grenha@fe.up.pt Lia Patrício Faculty of Engineering, University of Porto Portugal Leonel Nóbrega Madeira Interactive Technologies Institute, University of Madeira Portugal Larry Constantine Madeira Interactive Technologies Institute, University of Madeira Portugal Raymond P. Fisk Texas State University USA Abstract— Health information systems are becoming ubiquitous throughout healthcare delivery processes. Governments, enticed by the potential for improved patient care and cost reduction, are pushing for more integrated IT systems in healthcare. However, the successful adoption of these systems depends on the value they create as a service for healthcare professionals and how they support their activities. Following a call for more multidisciplinary research in health information systems and increased end-user participation in HIS development, this study presents a service perspective that considers users of health information systems (HIS) as active partners and co-creators of value, instead of passive recipients of the functionalities brought by these IT systems. From a service perspective we frame healthcare professionals as customers of HIS, and analyze how they can better support healthcare provision. We present an in-depth study of primary care professionals experience with the HIS of the Portuguese National Health Service. Experience was systematized using Customer Experience Modeling, a method that takes into account the holistic nature of experience. Results portray and evaluate HIS according to professionals’ experience requirements. They also show a fragmented reality where HIS usefulness is being hampered by integration and performance issues. HIS design guidelines are also posited. Keywords— Health Information Systems, Primary Care, Customer Experience, Service Science I. INTRODUCTION Health information systems (HIS) offer great promise in numerous ways, which include standardization and understandability of clinical information, improved information sharing between healthcare professionals, information traceability and ownership, reduced costs by cutting exams duplication in financially stressed national health services. The true benefits of HIS are more elusive. There is evidence of how HIS can damage healthcare provision [1], [2]. Authors have pointed out that poor user and organizational involvement during the development of such systems [3–6] results in the unfulfilled potential of HIS. As such, HIS fails not by lack of technical prowess, but by failing to support the actual healthcare delivery process and their professional’s needs. Following calls for increased user involvement and multidisciplinary research in HIS [3], [7], we introduce a service perspective for HIS development. Service can be broadly defined as the application of competences (knowledge and skills) by one entity for the benefit of another [8]. The customer plays a central role in the creation and delivery of services. Services should be developed to support customer needs and activities, and customers are viewed as active co- creators of value, as only through customer usage does service value come to life. Adopting a service perspective means that healthcare professionals become customers of the service provided by HIS. This means that developers should collaborate with professionals, learn from them, and adapt to their individual and dynamic needs [9]. This perspective helps focus on the development of useful, effective and efficient service experiences. Service experiences are holistic in nature and involve the users’ cognitive, affective, emotional, social and physical responses to the provided service [10]. By applying the customer experience concept to HIS, we are focusing on creating value for the customers, i.e. the healthcare professionals who use them. Instead of considering them mere recipients of functionalities we see professionals as active co- creators of value [11] within healthcare service provision. Customer experience centers the analysis on the professionals and views HIS as an enabler of their activities. It brings forth a broader, holistic perspective that frames system usage as part of a larger context, encompassing patients, other clinical and non-clinical staff, and different systems, devices and places. Customer Experience Modeling can be used [12] to systematize rich and complex experience data, and create operable models to be shared and discussed between stakeholders (e.g. physicians, nurses, software developers, 2013 IEEE 15th International Conference on e-Health Networking, Applications and Services (Healthcom 2013) 978-1-4673-5800-2/13/$26.00 ©2013 IEEE 362