Sociotechnical Aspect of Health Informatics

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Sociotechnical Aspect of Health Informatics

  1. 1. Sociotechnical Aspect of Health Informatics Nawanan Theera-Ampornpunt, MD, PhDExcept where citing other works August 22, 2012
  2. 2. Sociotechnical Systems • Coined in 1960s by Eric Trist, Ken Bamforth & Fred Emery • “An approach to complex organizational work design that recognizes the interaction between people and technology in workplaces.” (Wikipedia) • “Interaction between societys complex infrastructures and human behaviour.” (Wikipedia)http://en.wikipedia.org/wiki/Sociotechnical_system 2
  3. 3. People-Process-Technology Technology People Process 3
  4. 4. “People & Organizational Issues” (POI) • POI focuses on interactions between people and technology, including designing, implementing, and deploying safe and usable health information systems and technology. • AMIA POIWG addresses issues such as – How systems change us and our social and clinical environments – How we should change them – What we need to do to take the fullest advantage of them to improve [...] health and health care. – Our members strive to understand, evaluate, and improve human-computer and socio-technical interactions.http://www.amia.org/programs/working-groups/people-and-organizational-issues 4
  5. 5. “People & Organizational Issues” (POI) • We bring varied perspectives, methods, and tools from – Humanities, Social science, Cognitive science – Computer science and informatics – Business disciplines – Patient safety – Workflow – Collaborative work and decision-making – Human-computer interaction & Usability – Human factors – Project and change management – Adoption and diffusion of innovations – Unintended consequences – Policy.http://www.amia.org/programs/working-groups/people-and-organizational-issues 5
  6. 6. Common Themes in InformaticsProduced based on speaker’s personal opinion. Not based on real raw data. 6
  7. 7. Health IT Successes & FailuresKaplan & Harris-Salamone (2009) 7
  8. 8. Health IT Successes & Failures What success is • Different ideas and definitions of success • Need more understanding of different stakeholder views & more longitudinal and qualitative studies of failure What makes it so hard • Communication, Workflow, & Quality • Difficulties of communicating across different groups makes it harder to identify requirements and understand workflowKaplan & Harris-Salamone (2009) 8
  9. 9. Health IT Successes & Failures What We Know—Lessons from Experience • Provide incentives, remove disincentives • Identify and mitigate risks • Allow resources and time for training, exposure, and learning to input data • Learn from the past and from othersKaplan & Harris-Salamone (2009) 9
  10. 10. Health IT Successes & Failures Leviss (Editor) (2010) 10
  11. 11. Health IT Change ManagementLorenzi & Riley (2000) 11
  12. 12. Health IT Change ManagementLorenzi & Riley (2000) 12
  13. 13. Health IT Change ManagementLorenzi & Riley (2000) 13
  14. 14. Health IT Change ManagementLorenzi & Riley (2000) 14
  15. 15. Considerations for a successful implementation of CPOE Considerations Motivation for implementation CPOE vision, leadership, and personnel Costs Integration: Workflow, health care processes Value to users/Decision support systems Project management and staging of implementation Technology Training and Support 24 x 7 Learning/Evaluation/ImprovementAsh et al. (2003) 15
  16. 16. Minimizing MD’s Change Resistance • Involve physician champions • Create a sense of ownership through communications & involvement • Understand their values • Be attentive to climate in the organization • Provide adequate training & supportRiley & Lorenzi (1995) 16
  17. 17. Reasons for User Involvement • Better understanding of needs & requirements • Leveraging user expertise about their tasks & how organization functions • Assess importance of specific features for prioritization • Users better understand project, develop realistic expectations • Venues for negotiation, conflict resolution • Sense of ownership • Pare & Sicotte (2006): Physician ownership important for clinical information systemsIves & Olson (1984) 17
  18. 18. The Missing Piece in IT Adoption Technological Sophistication Functional Sophistication Integration Sophistication Managerial Sophistication Proposed AdditionTheera-Ampornpunt (2011) 18
  19. 19. Critical Success Factors in Health IT Projects Communications of plans & progresses Physician & non-physician user involvement Attention to workflow changes Well-executed project management Adequate user training Organizational learning Organizational innovativenessTheera-Ampornpunt (2011) 19
  20. 20. Theory of Hospital Adoption of Information Systems (THAIS)Theera-Ampornpunt (2011) 20
  21. 21. The “Special People”Ash et al. (2003) 21
  22. 22. The “Special People” • Administrative – CIO Leadership Level • Selects champions • Gains support – CEO • Possesses vision • Provides top • Maintains a thick skin level support and – CMIO vision • Interprets • Possesses vision • Holds steadfast • Maintains a thick skin • Connects with • Influences peers the staff • Supports the clinical support staff • Listens • Champions • ChampionsAsh et al. (2003) 22
  23. 23. The “Special People” • Clinical Leadership – Curmudgeons Level • “Skeptic who is usually quite vocal – Champions in his or her disdain • Necessary of the system” • Hold steadfast • Provide feedback • Influence peers • Furnish leadership • Understand other – Clinical advisory physicians committees – Opinion leaders • Solve problems • Provide a balanced • Connect units view • Influence peersAsh et al. (2003) 23
  24. 24. The “Special People” • Bridger/Support level – Skills – Trainers & • Possess clinical support team backgrounds • Necessary • Gain skills on the job • Provide help at the • Show patience, elbow tenacity, and • Make changes assertiveness • Provide training • Test the systemsAsh et al. (2003) 24
  25. 25. Unintended Consequences of Health IT• “Unanticipated and unwanted effect of health IT implementation” (ucguide.org)• Must-read resources – www.ucguide.org – Ash et al. (2004) – Campbell et al. (2006) – Koppel et al. (2005) 25
  26. 26. Unintended Consequences of Health ITAsh et al. (2004) 26
  27. 27. Unintended Consequences of Health IT • Errors in the process of entering and retrieving information – A human-computer interface that is not suitable for a highly interruptive use context – Causing cognitive overload by overemphasizing structured and “complete” information entry or retrieval • Structure • Fragmentation • OvercompletenessAsh et al. (2004) 27
  28. 28. Unintended Consequences of Health IT • Errors in the communication and coordination process – Misrepresenting collective, interactive work as a linear, clearcut, and predictable workflow • Inflexibility • Urgency • Workarounds • Transfers of patients – Misrepresenting communication as information transfer • Loss of communication • Loss of feedback • Decision support overload • Catching errorsAsh et al. (2004) 28
  29. 29. Unintended Consequences of Health IT • Errors in the communication and coordination process – Misrepresenting collective, interactive work as a linear, clearcut, and predictable workflow • Inflexibility • Urgency • Workarounds • Transfers of patients – Misrepresenting communication as information transfer • Loss of communication • Loss of feedback • Decision support overload • Catching errorsAsh et al. (2004) 29
  30. 30. Unintended Consequences of Health ITCampbell et al. (2006) 30
  31. 31. Unintended Consequences of Health ITCampbell et al. (2006) 31
  32. 32. Unintended Consequences of Health ITKoppel et al. (2005) 32
  33. 33. Unintended Consequences of Health ITKoppel et al. (2005) 33
  34. 34. Door #1 How do I open the door? 34From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 34
  35. 35. Door #2 How do I open the door? 35From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 35
  36. 36. Back to door #1 Door #1 36From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 36
  37. 37. Back to door #2 Door #2 37From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 37
  38. 38. How do I open the door? Door #3 38From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 38
  39. 39. Door #3 No instructions needed! 39From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 39
  40. 40. Design Principles • “Instructions/explanations are a sign of failure!” • Visibility • Affordances • Promoting recognition over recallFrom University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 40
  41. 41. Human-Computer Interaction • “A discipline concerned with the design, evaluation and implementation of interactive computing systems for human use” design evaluation implementation • Interdisciplinary – Computer Science; Psychology; Sociology; Anthropology; Visual and Industrial Design; …From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 41
  42. 42. Foundations of UI Design (1) • Human psychology – Short-term & long-term memory – Problem-solving – Attention • Design principles – Conceptual models; knowledge in the world; visibility; feedback; mappings; constraints; affordances 42From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 42
  43. 43. Foundations of UI Design (2) • Understanding users and tasks – Tasks, task analysis, scenarios – Contextual inquiry – Personas • User-centered design – Low, medium, and high-fidelity prototypes – visual design principles • Evaluating designs – Without users: cognitive walkthroughs; heuristic evaluation; action analysis – With users: qualitative and quantitative methods 43From University of Minnesota CS 5115 User interface design class (2008) by Loren Terveen 43
  44. 44. Human Factors • “The study of designing equipment and devices that fit the human body and its cognitive abilities” (Wikipedia) • Also known as “Ergonomics” • Specialties – Physical ergonomics – Cognitive ergonomics (including HCI) – Organizational ergonomics (including workplace design) – Environmental ergonomicshttp://en.wikipedia.org/wiki/Human_factors_and_ergonomics 44
  45. 45. Usability • “Refers to how well users can learn and use a product to achieve their goals and how satisfied they are with that process” (Usability.gov) • “The ease of use and learnability of a human-made object” (Wikipedia) • “The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use (ISO) • Key methodology: user-centered designhttp://en.wikipedia.org/wiki/Usability 45
  46. 46. Usability & Usable Systems • Usefulness = Usability + Utility (Jakob Nielsen) • Dimensions of usability – Learnability: How easy it is for users to accomplish basic tasks the first time? – Efficiency: Once learned, how quickly can users perform tasks? – Memorability: When returned after a period of non- use, how easily can users re-establish proficiency? – Errors: Frequency, severity, recoverability – Satisfaction: How pleasant it is to use?http://en.wikipedia.org/wiki/Usability http://www.useit.com/alertbox/20030825.html 46
  47. 47. User Experience • “The way a person feels about using a product, system or service” (Wikipedia) • Focuses on the feelings and perceptions of users • Subjectivehttp://en.wikipedia.org/wiki/User_experience 47
  48. 48. http://www.msn.com/ 48
  49. 49. http://www.google.com/ 49
  50. 50. HCI & Usability Resources • Usability.gov • Useit.com • Edwardtufte.com • National Institute of Standards and Technology (NIST) – http://www.nist.gov/healthcare/usability/index .cfm – Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records – NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Recordshttp://en.wikipedia.org/wiki/User_experience 50
  51. 51. “Most people make the mistake of thinking design is what it looks like. People think it’s this veneer – that the designers are handed this box and told, ‘Make it look good!’ That’s not what we think design is. It’s not just what it looks like and feels like. Design is how it works.” – Steve JobsImage Source: http://en.wikipedia.org/wiki/Steve_Jobs
  52. 52. References• Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system- related errors. J Am Med Inform Assoc. 2004 Mar-Apr;11(2):104-12.• Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inform. 2003 Mar; 69(2-3):235-50.• Ash JS, Stavri PZ, Kuperman GJ. A consensus statement on considerations for a successful CPOE implementation. J Am Med Inform Assoc. 2003 May- Jun;10(3):229-34.• Campbell, EM, Sittig DF, Ash JS, et al. Types of Unintended Consequences Related to Computerized Provider Order Entry. J Am Med Inform Assoc. 2006 Sep-Oct; 13(5): 547-556.• Ives B, Olson MH. User involvement and MIS success: a review of research. Manage Sci. 1984 May;30(5):586-603.• Kaplan B, Harris-Salamone KD. Health IT success and failure: recommendations from the literature and an AMIA workshop. J Am Med Inform Assoc. 2009 May-Jun;16(3):291-9. 52
  53. 53. References• Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005 Mar 9;293(10):1197-203.• Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc. 2000 Mar-Apr;7(2):116-24.• Paré G, Sicotte C, Jacques H. The effects of creating psychological ownership on physicians’ acceptance of clinical information systems. J Am Med Inform Assoc. 2006 Mar-Apr;13(2):197-205.• Riley RT, Lorenzi NM. Gaining physician acceptance of information technology systems. Med Interface. 1995 Nov;8(11):78-80, 82-3.• Theera-Ampornpunt N. Thai hospitals adoption of information technology: a theory development and nationwide survey [dissertation]. Minneapolis (MN): University of Minnesota; 2011 Dec. 376 p. 53

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