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1 Designing Health Designing Health Information Information
Technologies: Technologies: A Socio-Technical A Socio-Technical
PerspectivePerspectiveMadhu Reddy
College of Information Sciences and Technology
Center for Integrated Healthcare Delivery Systems
Penn State [email protected]
December 11, 2009
Talk Outline 2
Introduction Socio-Technical Perspective Research Site Case Study Summary
Who am I?3
Ph.D. - University of California, Irvine (2003)
Research Interests Medical Informatics Computer-Supported Cooperative Work
Research Approach Qualitative research methods Technology evaluation
INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY SUMMARYSUMMARY
Research Projects4
Current Projects Collaborative clinical decision-making1
Collaborative information behavior in dynamic and information-intensive environments2
Completed Projects HIT implementation and use3,4
Information needs of multidisciplinary patient care teams5
Inter-departmental coordination activities Patient transfer process6
Crises response7
INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY SUMMARYSUMMARY
“To Err is Human”6
INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY SUMMARYSUMMARY
Record archive 1935 and 2000
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IOM “Crossing the Quality Chasm” report, March 2001
Health Information Health Information TechnologiesTechnologies
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A “silver bullet” that will solve all our problems
Easily implantable Simple to use Reduce errors Improve patient outcomes Reduce/contain costs
BUT….
INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY SUMMARYSUMMARY
Reality is… (2006 AHA Reality is… (2006 AHA Survey)Survey)
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INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY
EMR Implementation None – 32%; Partial – 57%; Full – 11%
Some Issues (Full implementation) Size matters (500+ beds: 23%, <50 beds: 3%) Urban vs. Rural (16% vs. 5%) Teaching vs. Non-Teaching (17% vs. 9%)
Major BarriersInitial Cost – 94% Interoperability – 79%On-going Cost – 87% IT Staff – 67%Acceptance - 82% Inability to meet needs
- 62%SUMMARYSUMMARY
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How can we improve the design of health information
technologies (HIT)?
INTRODUCTION INTRODUCTION S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY SUMMARYSUMMARY
Challenges to Designing HITChallenges to Designing HIT 14
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Traditional Assumptions formulated in terms of technical challenges formalize work as routine
Clinical Healthcare Domain Highly collaborative Complex
Unpredictable Many exceptions (“routine exceptions”)
SUMMARYSUMMARY
Challenges to Designing HITChallenges to Designing HIT 15
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Mismatch system focus vs. collaboration in clinical
work work as routine vs. complexity of clinical
work
What is another approach?
SUMMARYSUMMARY
Technology Perspective Technology Perspective ContinuumContinuum
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
TECHNOLOGICAL TECHNOLOGICAL DETERMINISMDETERMINISM
SOCIAL SOCIAL DETERMINISMDETERMINISM
SOCIO-TECHNICAL PERSPECTIVESOCIO-TECHNICAL PERSPECTIVE
SUMMARYSUMMARY
Socio-Technical PerspectiveSocio-Technical Perspective17
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Important features View of social and technical issues as
intertwined Shifts attention away from the technology
in the abstract Expands focus to social/organizational
issues
Why is it important in healthcare? Collaboration implicit in the work Highly institutionalized social practices Adoption/acceptance major issues
SUMMARYSUMMARY
Surgical Intensive Care UnitSurgical Intensive Care Unit18
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION SUMMARYSUMMARY
Surgical Intensive Care Unit Surgical Intensive Care Unit TeamTeam
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
ResidentResident
ResidentResident
ResidentResident
FellowFellow
PharmacistPharmacistNurseNurseAttendingAttending
SUMMARYSUMMARY
Primary Working ConcernsPrimary Working Concerns20
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Patient Stabilization
Bed Management
SUMMARYSUMMARY
Case Study 1: Wireless Alert Case Study 1: Wireless Alert PagerPager
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION SUMMARYSUMMARY
Wireless Pager ExpectationsWireless Pager Expectations22
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Better collaboration
Quicker event notification
Delivery of more accurate information regarding critical events
““Proactive” vs. “Reactive”Proactive” vs. “Reactive”
SUMMARYSUMMARY
Problem 1: Maintaining Hierarchies Problem 1: Maintaining Hierarchies vs. Lowering Boundariesvs. Lowering Boundaries
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Creates loss of control Broadcast information to all physicians Can’t “control” bad information
Affects the context that hierarchy provides Information moving up the hierarchy
SUMMARYSUMMARY
SICU Alerting WorkflowSICU Alerting Workflow24
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
ResidentResident
FellowFellow
AttendinAttendingg
NurseNurse
SUMMARYSUMMARY
Problem 2: Information Overload and Problem 2: Information Overload and Missing ContextMissing Context
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Large number of pages/day 16 alerts/day No prioritization mechanism
Physical size of pager Provides limited context
Nurse’s role Is this really a problem?
SUMMARYSUMMARY
Problem 3: Missing Feedback Problem 3: Missing Feedback MechanismsMechanisms26
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Unidirectional Physician only receives information Can’t respond via pager
Lack of feedback Broadcast problem but not who responds Maintaining the balance between trust and
verification
SUMMARYSUMMARY
Organizational and Technical Issues Simple technical fixes
Two-way pagers Pagers with different tones/alerting
mechanism App phones (iphone, droid, etc.)
Harder organizational issues Changing the role of the nurses Changing the institutionalized work practices
of the house staff
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION SUMMARYSUMMARY
SummarySummary28
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
What am I not arguing for? NOT arguing that changing how people work is
bad or unnecessary NOT arguing that the technology itself isn’t
important
What am I arguing for? Vital to understand the relationship between
the technology, work, and organizational structure
SUMMARYSUMMARY
SummarySummary29
S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Technical expectations vs. organizational activities & roles Ex: Misunderstanding who the real users of the
system are
Tackling these issues requires collaboration between different disciplines (i.e. health sciences, social sciences, information sciences, computer science, others)
SUMMARYSUMMARY
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
Thank You!
SUMMARYSUMMARY
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S-T PERSPECTIVES-T PERSPECTIVE RESEARCH SITERESEARCH SITE CASE STUDY CASE STUDY INTRODUCTION INTRODUCTION
ReferencesReferences1. Zhu, S., J. Abraham, S. Paul, M. Reddy, J. Yen, M. Pfaff, and C. DeFlitch. (2007). R-
CAST-MED: Applying Intelligent Agents to Support Emergency Medical Decision Making Teams. In Proc. of the 11th Conference on Artificial Intelligence in Medicine (AIME 07).
2. Reddy, M. and B.J. Jansen. (2008) A Model for Understanding Collaborative Information Behavior in Context: A Study of Two Healthcare Teams. Information Processing and Management. 44(1): 256-273.
3. Reddy, M, Pratt, W., Dourish, P., and Shabot, M.M. (2003). Sociotechnical Requirements Analysis for Clinical Systems. Methods of Information in Medicine, 42, 437-444.
4. Reddy, M., McDonald, D., Pratt, W., and Shabot, M. (2005). Technology, Work, and Information Flows: Lessons from the implementation of a wireless alerts pager system. Journal of Biomedical Informatics, 38/3. pp. 229-238.
5. Reddy, M. and P. Spence. (2006). Finding Answers: Information Needs of a Multidisciplinary Patient Care Team in an Emergency Department. In Proc. of American Medical Informatics Association Fall Symposium (AMIA'06). Washington, DC. Nov. 11 –15, 2006. pp. 649-653.
6. Abraham, J. and Reddy, M. (2008). “Moving Patients Around: A Field Study of Coordination between Clinical and Non-Clinical Staff in Hospitals.” In Proceedings of ACM Conf on Computer Supported Cooperative Work (CSCW’08). San Diego, CA. Nov. 8-12, 2008. pp. 225-228.
7. Reddy, M., Paul, S., Abraham, J., McNeese, M., DeFlitch, C., and Yen, J. (2009). Challenges to Effective Crisis Management: Using Information and Communication Technologies to Coordinate Emergency Medical Services and Emergency Department Teams. International Journal of Medical Informatics. 78: 259-269.
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