Digital Document Workflows in a Hospital Intranet: A Case Study

Thesis Abstract

The rapid digitization of hospital documentation and the move toward integrated intranet workflows have created both opportunities for enhanced care coordination and challenges related to data interoperability, process rigidity, and user adoption. This study investigates digital document workflows within the intranet of a tertiary care hospital to understand how workflow design, system integration, and organizational factors influence efficiency, data quality, and clinical decision support. The problem addressed centers on persistent bottlenecks in patient information flow, duplication of effort, and limited visibility across departments despite the deployment of a hospital-wide document management platform. The aim is to evaluate the effectiveness of digital document workflows in supporting timely and accurate clinical processes and to identify design and organizational determinants of successful adoption. Specific objectives are (1) to map the current workflow pathways for key document types (admission notes, orders, laboratory reports, imaging requests, and discharge summaries); (2) to assess the impact of workflow automation on processing time, error rate, and information accessibility; (3) to examine user-perceived usability, learning curve, and satisfaction among physicians, nurses, and administrative staff; (4) to analyze data governance, privacy, and compliance practices within the intranet environment; (5) to develop a conceptual model linking technology, human factors, and organizational context to workflow performance; and (6) to provide evidence-based recommendations for optimizing digital document processes. Methodologically, the study adopts a mixed-methods, case-study design anchored in activity theory and the Technology Acceptance Model (TAM) to interpret user interaction with the hospital intranet. The population comprises hospital staff across four departments (Emergency, Radiology, Oncology, and Medical Records) at a 900-bed tertiary hospital. A purposive sample of 120 respondents, stratified by role (40 physicians, 40 nurses, 20 clerical staff, 20 allied health professionals), will be invited to participate in a structured survey, complemented by 30 in-depth interviews to explore nuanced experiences with document workflows. System usage logs will be analyzed for 12 months to quantify processing times, handoffs, and error rates. Data collection instruments include a validated workflow audit checklist, the System Usability Scale (SUS), and a customized patient information quality rubric aligned with ISO 25012 standards. Quantitative data will be analyzed using descriptive statistics, multiple regression to determine predictors of workflow efficiency, and time-motion analysis to quantify task durations. ANOVA will compare workflow performance across departments. Mediation analysis will test whether perceived ease of use and usefulness mediate the relationship between system features (automation, interoperability) and user satisfaction. Qualitative data from interviews will undergo thematic analysis to identify recurring patterns in perceived barriers, enablers, and socio-technical tensions. A convergent parallel design will integrate findings to triangulate results and strengthen inferences about causality and context. The research will also apply a conceptual model that situates digital document workflows within the interplay of technology artifacts, human action, and organizational norms. Key expected findings include (a) a positive association between automation levels in document routing and reduced completion times; (b) improvements in data accuracy and reduced duplicate entries in integrated modules; (c) variations in user satisfaction tied to role-specific workflows and training adequacy; (d) identification of governance gaps related to access control, audit trails, and consent management; and (e) a robust model linking workflow performance to combined effects of system usability, interoperability, and organizational support. The study contributes to knowledge by empirically elucidating how hospital intranet-enabled document workflows influence operational efficiency, data quality, and care coordination, offering transferable insights for healthcare facilities pursuing similar digital initiatives. Practical implications include recommendations for targeted training, enhanced interoperability standards, redesign of bottleneck-prone workflow steps, and strengthened governance frameworks. The main conclusion anticipates that strategic alignment of automations and user-centric design, underpinned by robust data governance, significantly improves document workflow performance and clinical information continuity. Recommendations emphasize iterative workflow redesign, continuous usability assessment, and scalable implementation of interoperable modules to sustain improvements across departments.