‘Synergy between the technology, the user and their work is an important factor in the safe and efficient use of clinical information systems’ (Callen et al. 2006: 643). The two peer-reviewed articles in this issue of HIMJ reflect the importance of research into how work is carried out in both clinical and administrative areas of healthcare. Work environments of health professionals are diverse and complex. The context of work includes the structure and functions of the organisation overall and the specific department or unit, other people at work and the technologies in use. This work domain is influenced by external factors such as political, social, cultural and economic considerations as well as the individual’s knowledge, skills and motivation. Increasingly work is undertaken in multidisciplinary teams which add further complexity to the work context.

Abstract
The influence of organisational factors on the quality of hospital coding using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) was investigated using a mixed quantitative-qualitative approach. The organisational variables studied were: hospital specialty; geographical locality; structural characteristics of the coding unit; education, training and resource supports for Clinical Coders; and quality control mechanisms. Baseline data on the hospitals’ coding quality, measured by the Performance Indicators for Coding Quality tool, were used as an independent index measure. No differences were found in error rates between rural and metropolitan hospitals, or general and specialist hospitals. Clinical Coder allocation to ‘general’ rather than ‘specialist’ unit coding resulted in fewer errors. Coding Managers reported that coding quality can be improved by: Coders engaging in a variety of role behaviours; improved Coder career opportunities; higher staffing levels; reduced throughput; fewer time constraints on coding outputs and associated work; and increased Coder interactions with medical staff.

Abstract
In order to achieve the full potential of information technology in healthcare, information systems must have the ability to share and exchange data, which requires the support of standardised medical terminology, such as Systematised Nomenclature of Medicine – Clinical Terms (SNOMED-CT). The Royal Prince Alfred Intensive Care Service and the School of Information Technologies, University of Sydney have been collaborating for over two years, developing pioneering software initiatives for clinical information systems (CIS). More recently, the collaboration resulted in the development of two prototype systems. The Ward Round Information System (WRIS) has been designed to convert clinicians’ clinical notes into the formal medical encoding ontology SNOMED-CT, thus enabling more consistent descriptions of patient conditions and allowing large-scale retrieval and analysis from the narrative part of the patient record. In addition, a Clinical Data Analytics Language (CDAL) system has also been developed and is designed to answer questions of the data stored in the CIS. It will assist clinicians in the management of vast amounts of complex information generated during an ICU admission and ultimately improve the quality and efficiency of care. CDAL provides clinicians with the ability to frame any question about their data in their database and get the answer almost immediately. Both systems went live in October 2007, and this report summarises the background, purpose, and progress thus far.

© 2008 Health Information Management Association of Australia Limited