ANALYTIC MEMO ABOUT THE FIELD WORK
AUTHOR:
DATE:
FARAJA MUKAMA
19TH NOVEMBER 2001
Memo Outline:
 Introduction
 Exploring the methods used and Reflections on the methods
 Thoughts and questions generated for research design - (Theoretical
questions and concerns)
 What is required to verify or to generalize from qualitative research findings.
INTRODUCTION
Area of interest
My area of interest is the field of Health Information Systems. This is the field
where I expect to do my research work. It is a new field to me so I expect to use
the knowledge from INF-QUAL, first to get an overview of the field and then to do
my research: such as how to conduct interviews and observations as a means of
data collection while in the field site.
The field site:
Regarding the field of Health Information Systems, the study was done to the
Rikshospitalet – Norway, where by we had an orientation section, observation
section and interview section. The main focus in both sections was on the Electronic
Patient Record.
A map showing where Rikshospitalet is situated
The Rikshospitalet building
i.e. north of the center of Oslo, near Ullevål Stadion
1

The orientation section was done by Dr. Invar Berge, who is a doctor at the
Rikshospitalet and he also took part in implementing the electronic system for
patient’s records.
-
The orientation give an overview on the Norwegian Health care System
as well as the Rikshospitalet as part of it i.e. where does it fit in the
Norwegian Health care System. Also it gave the essence of the
Electronic Patient Record as well as the challenges in its use.
-
It was conducted in room 218, Forskningsparken II, from 12:30pm to
15:00 on the 16th of October 2001

The observation section was done by Per Mathise – MD, who is the Senior
Consultant in the Medical Outpatient Department; together with me and my
colleagues.
-
The observation showed the use of the Electronic Patient Record
System in Clinical practice.
-
It was conducted at the Rikshospitalet, from 10:00 am to 11:30 am on
the 30th of October 2001.

During the Interview section Prof. Dr. Med. Albert Paus, who is the head of
the Rheumasurgery department was the interviewee and me (Faraja) and
Gertrudes were the Interviewers. Pro. Dr. Paus has a three years
experience on the use of the Electronic Patient Record.

Departments in the Risk hospital (Note: Not all the department are shown)
Management Administration
IT department
Surgical
department
Medical
department
Eye
department
Personnel department
Service department
Clinic
department
Radiology
department
2
EXPLORING THE METHODS USED (Findings) and REFLECTIONS ON THE
METHODS
Orientation:
The following is a summary of the Orientation section.

Norwegian Health care System: Information flow
The Norwegian Healthcare System is divided into five regions, whereby each
region has one regional hospital; Rikshospitalet is one of the regional hospitals.
Before the regional hospitals there other local hospitals: The structure can be
represented by considering a sick person who has to be attended at different levels
before going to the regional hospital:
Sick
person
Primary
Doctor
Local
hospital
Regional
Hospital
Note: The patient is referred to another level when the particular level can not
diagnose him.

The essence of the Electronic patient record
The Electronic patient record started in 1995, aiming at reducing the paper
record problems such as loss of documents and slow access of information.
This can be shown by the following diagram - showing the flow of information
from one hospital level to another (paper work at each level transferred to
another level):
Paper (very little information, usually lab results)
Lacking electronic communication
Computerized
Sick
person
Local
Hospital
Papers (letters) e.g. Ex-rays
Primary
Doctor
Treatment
Local
hospital
Examination
Regional
Hospital
Interview
Papers
Follow-ups
3

Challenges in the use of the Electronic Patient record.
There are some challenges that are being faced like, little communication
between the departments since not all the departments are not using the
system yet.
Before the orientation day, we had prepared questions to be asked during the
interview (E.g. how did they come up with the project1). On my side the orientation
answered most of the questions we had. This was very useful for me as I entered
the field (for the observation/interview) having some ideas on what is being done
through the use of the Electronic patient record. The most important part of the
Orientation is that we were given some practical information (i.e. who to meet,
where to meet him, a formal entrance form “Taushetserklæring for Rikshospitalet”
to adhere with the rules for visiting the hospital) regarding the Observation/
interviews we were going to conduct at the Rikshospitalet.
Observation:

During the observation we were not organized in the sense that we had no
prepared questions to ask. I considered the observation we did partly as
unstructured interview since everyone was asking questions in a randomly
order depending on what he/she wants to know about the use of the
Electronic Patient record.

However we had an overview on the use of the system2 by knowing who are
the users of the system- receptionists, doctors , nurses and secretaries, the
system security- the use of login names, passwords and professional rights 3
, the system design- designed basing on the paper format used before4 , the
system contents(items)- menus for finding patients’ records and advantages
4
of using the system (according to the Per Mathise – MD’s experience), one
being the improvement of the quality of his work.
After the observation it was like all the questions I had in mind concerning the
Electronic Patient Record were answered, but after discussing with my fellow
colleague (member in the interview section), we decided that we would ask the
same questions we had prepared for the interview to get different views from
different users.
The observation section made me to have the idea of how difficult it is to find
someone in the Rikshospitalet; I saw the Rikshospitalet as a large place with a lot
of entrances (which are confusing), with almost the same color around. To get
familiar to the place I would have to visit (for observation) the place more that one
time.
Interview:

For the interview we had twelve prepared questions (written), which acted
as a guide for the interview. We decided that we will be asking the questions
in order; one interviewer after another. While the interview was going on, we
(interviewers) were asking some additional questions for the purpose of
giving a clear explanation (to the interviewee) at the same time getting a
clear explanation (from the interviewee) about the particular written
question.

The interviewee seemed to be optimistic about the use of the system;
concerning our 11th question “What are the anticipated long-term effects of
the system on the delivery of medical care?” The interviewee answered
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that: “the system will provide easier communication within hospitals, between hospitals
and between hospitals and primary healthcare. In future each patient will have his/her own
case history in the system all the time”.
In my views I think that hospitals will not get rid of paper records, the
interviewee when asked about this he suggested that “with strict security,
hospitals may get rid of papers sometimes in the future.”

I considered the interview as a way of getting a clear understanding on what
was not clear during the observations section. This because our observation
section consisted of a large number of participants and we were not
organized.
THOUGHTS AND QUESTIONS GENERATED FOR RESEARCH DESIGN (THEORETICAL QUESTIONS AND CONCERNS)
This experience made/makes me think of how I am going to conduct my research
during data collection. The main questions I have are:

How should I organize the methods (what method should be done first and
what should be done last) during my research?

Should I include all the methods (orientation, observation and interview) we
used?

How many how many times should I observe the setting or how may
interviewee should I interview to enable me to obtain reasonable
information?
My main concern is on getting data from a range of individuals so that I will not be
biased on relaying on only one source (individual) of information.
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I think organizing the research findings by starting with the orientation section,
following the observation section and lastly the interview section is a good way to
follow when doing the research: orientation section is necessary for giving a
researcher an overview of what the field site is like; for the researcher to gain
entrance to the field site. The observation section allows the researcher to be
familiar with the field site. The Interview section is useful for providing answers to
the researcher’s questions.
WHAT IS REQUIRED TO VERIFY OR TO GENERALIZE FROM QUALITATIVE
RESEARCH FINDINGS.
I think it is very difficult to verify or to generalize the information obtained from
qualitative research findings.

What I am suggesting is that a researcher can verify what he/she has
interpreted by gathering feedback about his/her conclusions from
participants in the setting studied and from others familiar with the setting (if
possible). Also through collecting data from a range of individuals and
settings (if there is enough time), can help a researcher no to be biased on
only one source of information.
1
Developing an Electronic Patient Record
An Electronic Patient Record
3
Each user when logs in a system he/she can access information according to his/her professional rights.
4
The format on the paper records the hospital is using.
2
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