Health information technology: fallacies and sober realities

In the paper

“Equating HIT usage with design success can be misleading and may promulgate inappropriate policies to improve ' use ' . 67”

What the sources say

• Not checked yetcites [67] source

In the paper

“current efforts aimed at the nationwide deployment of health care ITwill not be sufficient to achieve the vision of 21st-century health care, and may even set back the cause if these efforts continue wholly without change from their present course.”

What the sources say

• Not checked yetcites [14] Stead WW Lin HS , eds. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington DC: National Academies Press, 2009.

In the paper

“Currently, there are no regulatory requirements to evaluate HIT system safety even though these systems are known to directly affect patient care in both positive and negative ways. 2 17 18 27 e 34”

What the sources say

• Not checked yetcites 2 17 18 27 e 34

In the paper

“changing the order of medication options on a drop down pick list will influence clinicians ' ordering behavior.”

In the paper

“A passive monitoring approach, as currently suggested by the Office of the National Coordinator, 49 seems likely to be both expensive and ultimately ineffective.”

What the sources say

• Not checked yetcites [49] Egerman P Probst M . Memorandum to David Blumenthal: Adoption-Certification Workgroup HIT Safety Recommendations. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_911847_0_0_18/AdoptionCertificationLetterHITSafetyFINAL508.pdf (accessed 17 Aug 2010).

In the paper

“Change how clinicians do their daily work, thus introducing new potential failure modes. 16 18 28 35 e 39”

What the sources say

• Not checked yetcites 16 18 28 35 e 39

In the paper

“or reduce costs. 13”

What the sources say

• Not checked yetcites [13] source

In the paper

“human factors engineers, social psychologists, and patient safety researchers long ago debunked the bad apple theory of human error, replacing it with the more accurate and useful systems view of error, 21 62 63”

What the sources say

• Not checked yetcites 21 62 63

In the paper

“The complexity of HIT systems and the risk of potentiating serious error is sufficiently significant to demand effective regulatory oversight. 46”

What the sources say

• Not checked yetcites [46] Hoffman S Podgurski A . Finding a cure: the case for regulation and oversight of electronic health record systems. Harv J Law Technol 2008;22:104–65.

In the paper

“This mismatch between who benefits and who pays leads to incomplete or inaccurate data entry ( ' garbage in d garbage out ' ), inefficiency, workarounds, and poor adoption. 74”

What the sources say

• Not checked yetcites [74] Abbott P Coenan A . Globalization and advances in information and communication technologies: The impact on nursing and health. Nurs Outlook 2008;58:238–46. source

In the paper

“Many catastrophes in complex sociotechnical systems (eg, Three Mile Island) occur in such situations, particularly when the technology does not communicate effectively with its human users.”

In the paper

“computers are very good at repeatedly doing whatever they were told to do, just like a well-trained animal (ie, ' sitstay ' ). Computers implement human-derived rules and with a degree of consistency much higher than human workers.”

In the paper

“Otherwise, unintended consequences, such as physicians and hospitals investing in HIT to the exclusion of what might actually be more effective local strategies (eg, use of nurse case managers or process redesign), may occur.”

In the paper

“Healthcare is a complex sociotechnical system where simple metrics can mislead because they do not adequately consider the context of human decisions at the time they are made.”

In the paper

“computers are much more likely than humans to perform their clever and complex tricks at inappropriate times.”

In the paper

“Computers cannot be described as being inherently ' smart ' .”

In the paper

“As a result, problems have been framed too narrowly, leading to impoverished designs and disappointing ' solutions ' . 85”

What the sources say

• Not checked yetcites [85] source

In the paper

“computer displays are not yet as portable, flexible, or well-designed as paper. 83”

What the sources say

• Not checked yetcites [83] Sellen AJ Harper RHR . The Myth of the Paperless Office. Cambridge, MA: MIT Press, 2002. source

In the paper

“People, on the other hand, are smart, creative, and context sensitive. 79”

What the sources say

• Not checked yetcites [79] Norman DA . Things That Make Us Smart: Defending Human Attributes In The Age Of The Machine. New York: Basic Books, 1994.

In the paper

“the promulgation of ' meaningful use ' may lead to undesirable consequences if such use is not contextually grounded and tied to improved efficiency, learning, ease of use, task and information flow, cognitive load, situation awareness, clinician and patient satisfaction, reduced errors, and faster error recovery.”

In the paper

“The 'fi eld of dreams ' fallacy is well-known in other domains where it is also referred to as the ' designer fallacy ' or ' designercentered design ' . 77”

What the sources say

• Not checked yetcites [77] Hoffman RR Militello LG . Perspectives on Cognitive Task Analysis. New York: Taylor and Francis, 2009. source

In the paper

“User-created paper artifacts typically support patientspecific cognition, situational awareness, task and information communication, and coordination, all essential to safe quality patient care.”

In the paper

“most clinicians are not experts in device design, user interface design, or the relationship between HIT design and performance.”

In the paper

“The paper forms are not simple data repositories that, once computerized, could be eliminated. Rather such ' scraps ' of paper are sophisticated cognitive artifacts that support memory, forecasting and planning, communication, coordination, and education.”

In the paper

“Paper will persist, and should persist, if HIT is not able to provide similar support.”

In the paper

“By seeing only what they know, such teams do not understand how clinical work is really carried out, what clinicians ' real needs are, and where the potential hazards and leverage points lie.”

In the paper

“some clinical decision support (CDS) rules force clinicians to stop and respond to the CDS, interrupting their work, substituting the designer ' s judgment for that of the clinician. 71”

What the sources say

• Not checked yetcites [71] Bisantz AM Wears RL . Forcing functions: the need for restraint. Ann Emerg Med 2008;53:477–9. source

In the paper

“it is misguided to believe that healthcare is unique or that no one outside of the domain could possibly understand it.”

In the paper

“it takes special training and skills to evaluate a human e computer interface, assess the usability of a system, or predict the changes in communication patterns and social structures that a design might induce.”

In the paper

“a lack of use is not evidence of a flawed system d clinicians may ignore features like reminders for legitimate reasons.”

In the paper

“Technology can be at its worst, and humans at their best, when novel and complex situations arise.”

In the paper

“Validation of HITcannot be achieved by asking a clinician if they like the design. Validation requires thorough experimental testing of the design based on well-defined performance criteria.”

In the paper

“However, use may not truly be meaningful in a clinical sense until HIT truly supports users ' needs.”

In the paper

“While it may not take 60 years for HIT to become as safe, if we do not change from our current course, it never will be.”

In the paper

“These challenges will only be overcome by collaborating substantively with those who can contribute unique and important expertise such as human factors engineers, applied psychologists, medical sociologists, communication scientists, cognitive scientists, and interaction designers.”

• Also stated in: § WHAT SHOULD WE DO NOW? · p. 5 · plain

  “HIT stands to benefit in the same way.”

In the paper

“Exemplary research on relevant topics has been carried out for several decades, 89 e 98 but it does not seem that commercial HIT has benefited adequately from these findings.”

What the sources say

• Not checked yetcites 89 e 98

In the paper

“HITaffords real opportunities for improving quality and safety. However, at the same time, it creates substantial challenges, especially during everyday clinical work.”

In the paper

“These steps alone will require a significant investment by vendors, healthcare organizations, and government funders.”

In the paper

“Current meaningful use rules and deadlines leave little time for HIT product improvement and testing, incentivizing rapid implementation of whatever is available”