PubMed · 16519174
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Daloni Carlisle. 2006-02-16. Practice made perfect.. https://pubmed.ncbi.nlm.nih.gov/16519174/
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The effective use of information technology (IT) is a crucial component for the delivery of effective services in health care. Current approaches to medical informatics (MI) research have significantly contributed to the success of IT use in health care but important challenges remain to be addressed. We believe that expanding the multi-disciplinary basis for MI research is important to meeting these research challenges. In this paper, we outline theories and methods used in information systems (IS) research that we believe can inform our understanding of health care IT applications and outcomes. To do so, we discuss some general differences in the focus and methods of MI and IS research to identify broad opportunities. We then review conceptual and methodological approaches in IS that have been applied in health care IT research. These include: technology-use mediation, collaborative work, genre theory, interpretive research, action research, and modeling. Examples of these theories and methods in healthcare IS research are illustrated.
In any collaborative work settings, people naturally develop physical tools and associated work processes that support the management of the interdependencies in information, materials, and social needs. Field studies of management of operating rooms pointed out that collaborative work is supported by an infrastructure that is composed of mostly non-computerized, physical components. The supporting infrastructure is jointly maintained and exploited, with constantly evolving patterns of usage, in response to complexity of coordination needs and the uncertain environment. To represent status and plans, users seem to invent structures based both on idiosyncratic preferences and on negotiated symbols. The fluidity and ease of restructuring workplaces to support collaborative work may be explained in part by the high resolution and bandwidth of workplaces: a large number of ways in which workers could structure their work and a high capacity to convey rich information and meanings quickly to collaborators. We argue that to support health care workers, designers of computer supported cooperative work (CSCW) systems should learn how the physical and perceptual properties of workplaces are exploited, and that CSCW systems should be designed to allow maximum freedom of restructuring and reconfiguring as part of workplaces to enhance bandwidth and resolution of representation and communication.
OBJECTIVE: To describe the perceived effect of computerized physician order entry (CPOE) on professional collaboration, workflow and quality of care. DESIGN: Semi-structured interviews with experts involved in the design, implementation and evaluation of computerized physician order systems in the United States. MEASUREMENTS: The interview transcripts were analyzed using six key concepts that identify context, professional collaboration, workflow and quality of care. RESULTS: The interviews reveal the complexity of CPOE. Although providers enter the orders, others collaborate in the decision-making process. There is a profound impact on workflow beyond that of the provider. While quality of care is the main impetus for implementation, it remains terribly difficult to measure the impact on quality. CONCLUSIONS: A proper understanding of CPOE as a collaborative effort and the transformation of the health care activities into integrated care programs requires an understanding of how orders are created and processed, how CPOE as part of an integrated system can support the workflow, and how risks affecting patient care can be identified and reduced, especially during hand-offs in the workflow.