Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis

Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization’s sociotechnical system—its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical Analysis (ISTA). ISTA captures common types of interaction with special emphasis on recursive processes, i.e., feedback loops that alter the newly introduced HIT and promote second-level changes in the social system. ISTA draws on prior studies of unintended consequences, along with research in sociotechnical systems, ergonomics, social informatics, technology-in-practice, and social construction of technology. We present five types of sociotechnical interaction and illustrate each with cases from published research. The ISTA model should further research on emergent and recursive processes in HIT implementation and their unintended consequences. Familiarity with the model can also foster practitioners’ awareness of unanticipated consequences that only become evident during HIT implementation.     

The Business Value of Health Care Information Technology

The American health care system is one of the world''s largest and most complex industries. The Health Care Financing Administration reports that 1997 expenditures for health care exceeded one trillion dollars, or 13.5 percent of the gross domestic product. Despite these expenditures, over 16 percent of the U.S. population remains uninsured, and a large percentage of patients express dissatisfaction with the health care system. Managed care, effective in its ability to attenuate the rate of cost increase, is associated with a concomitant degree of administrative overhead that is often perceived by providers and patients alike as a major source of cost and inconvenience. Both providers and patients sense a great degree of inconvenience and an excessive amount of paperwork associated with both the process of seeking medical care and the subsequent process of paying for medical services.Traditionally, health practitioners have sought a return to traditional fee-for-service payment to mitigate the inconvenience associated with managed care. More populist proposals include universal health insurance or mandatory enrollment in health maintenance organizations. Advocates of managed care argue that the business methods required for effective trials of this approach are only beginning to be realized. By all accounts, information technology is a necessary part of these initiatives, but there is universal consensus that our current systems are inadequate to the task. (Oxford Health System''s difficulties in 1998, for example, have been attributed in part to inadequate deployment of information technology.) To this author, the model for the current generation of health care information systems is strikingly similar to that for the information systems employed by the Internal Revenue Service. In each case, the system allows for low-cost changes to administrative code brought about by legislation, but in both cases the “ripple effects” of additional complexity and administrative burden far exceed the cost of immediate change. To paraphrase a quotation attributed to Major Richard Dailey, made about his police force during the 1998 Chicago Democratic Convention, our information systems “are not here to create disorder; they are here to preserve disorder.”This case explores one alternative source for models in health care delivery. Through an examination of a typical patient experience, we explore Porter''s notion of the value chain and “just-in-time” logistics common to successful organizations like Wal-Mart and Amazon.com (see Suggested Readings). We close with a brief discussion of how these logistics and inventory systems apply to health care. Clearly, logistics are important in patient care, accounts receivable are a cause of severe working capital problems in health care, and the logistics of caring for patients are becoming more complex. But the concepts we discuss have an even greater importance: Effective management of these issues through information technology may restore our most precious commodity—time.     

Information Technology in the Future of Health Care

Technology advances have changed the face of health care. This paradigm shift blurred the boundaries between public health, acute care, and prevention. Technology's role in the diagnosis, treatment assignment, follow-ups, and prevention will be reviewed and future impact projected. The understanding of shift in our expectation for each aspect of health care is critical so that levels of success are understood. Technology advances in health care delivery will be discussed. Specific applications are presented and explained and future trends discussed. Four applications are defined, and related to categories of technologies and their attributes.     

Advancing Personalized Health Care through Health Information Technology: An Update from the American Health Information Community's Personalized Health Care Workgroup

The Personalized Health Care Workgroup of the American Health Information Community was formed to determine what is needed to promote standard reporting and incorporation of medical genetic/genomic tests and family health history data in electronic health records. The Workgroup has examined and clarified a range of issues related to this information, including interoperability standards and requirements for confidentiality, privacy, and security, in the course of developing recommendations to facilitate its capture, storage, transmission, and use in clinical decision support. The Workgroup is one of several appointed by the American Health Information Community to study high-priority issues related to the implementation of interoperable electronic health records in the United States. It is also a component of the U.S. Department of Health and Human Services'' Personalized Health Care Initiative, which is designed to create a foundation upon which information technology that supports personalized, predictive, and pre-emptive health care can be built.     

卫生保健课程教学误区之我见

卫生保健课程是以贯彻＂预防为主＂的方针、实现＂健康为人人,人人为健康＂的一门重要学科。笔者根据数年的教学实践,结合学生的课堂调查结果,总结卫生保健课程教学中常见的误区,以期同行在教学中避免走进误区,更好地为教学服务。     

信息素养是驾驭医疗卫生信息化的“通行证”

当今社会,每天都有成千上万兆比特的信息铺天盖地倾泻而来。医疗卫生领域也不例外,医疗业务信息、公共卫生信息等等处于熵增状态,擢发难数的医疗卫生信息,无论在保障医药卫生体制改革各项任务的贯彻实施,     

A Systematic Review of Patient Acceptance of Consumer Health Information Technology

A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.     

老年性高血压患者的自我保健

高血压病是一种常见病、多发病，在各种心血管疾病中患病率最高。随着社会经济的发展，生活水平的提高以及人口的老龄化，我国高血压患病率在持续上升且上升速度逐年加快。此病危害涉及诸多方面，尤其是老年患者更为突出。如何自我保健，是一个重要的课题。下面谈点体会：老年患者应根据自己的生理、心理特点，合理饮食、适当运动、戒烟限酒、睡眠适中、规范用药、心理平衡。只有这样，才能减轻、减少高血压病并发症的危害，使老年患者长寿。     

基于无线扫描技术的健康护理信息系统构建

以分析医院信息化管理现状为出发点,提出建立一个运用无线扫描技术的健康护理信息系统解决方案,运用软件工程理论,进行需求分析、系统总体设计和详细设计,完成实现、测试与应用,对系统的实际应用效果进行分析和评价。     

健康教育路径在骨外伤患者护理观察

目的:探讨健康教育在骨外伤患者护理中的效果观察。方法:采用护患面对面宣教的方式对本院外科2006—2008年收治的首次住院的骨外伤患者100例实施统一的健康教育,观察健康教育前后患者一般自我效能感、骨外伤知识知晓率及满意度的变化。结果:健康教育后患者一般自我效能(32.6±2.3)、骨外伤知识知晓率99%均明显高于健康教育前的(21.6±2.0)、82%,差异有统计学意义(P<0.05)。结论:健康教育对于增加骨外伤患者自我效能感,增加患者对骨外伤相关知识的了解,提高对护理工作的满意度,使患者能够最大限度的缩短治疗时间及加快康复的进程具有重要意义。     

The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry

Background

Computerized provider order entry (CPOE) systems can help hospitals improve health care quality, but they can also introduce new problems. The extent to which hospitals experience unintended consequences of CPOE, which include more than errors, has not been quantified in prior research.

Objective

To discover the extent and importance of unintended adverse consequences related to CPOE implementation in U.S. hospitals.

Design, Setting, and Participants

Building on a prior qualitative study involving fieldwork at five hospitals, we developed and then administered a telephone survey concerning the extent and importance of CPOE-related unintended adverse consequences to representatives from 176 hospitals in the U.S. that have CPOE.

Measurements

Self report by key informants of the extent and level of importance to the overall function of the hospital of eight types of unintended adverse consequences experienced by sites with inpatient CPOE.

Results

We found that hospitals experienced all eight types of unintended adverse consequences, although respondents identified several they considered more important than others. Those related to new work/more work, workflow, system demands, communication, emotions, and dependence on the technology were ranked as most severe, with at least 72% of respondents ranking them as moderately to very important. Hospital representatives are less sure about shifts in the power structure and CPOE as a new source of errors. There is no relation between kinds of unintended consequences and number of years CPOE has been used. Despite the relatively short length of time most hospitals have had CPOE (median five years), it is highly infused, or embedded, within work practice at most of these sites.

Conclusions

The unintended consequences of CPOE are widespread and important to those knowledgeable about CPOE in hospitals. They can be positive, negative, or both, depending on one’s perspective, and they continue to exist over the duration of use. Aggressive detection and management of adverse unintended consequences is vital for CPOE success.     

北京市社区卫生服务满意度横断面调查结果分析

目的 分析患者对社区卫生服务的满意度及其关联因素,推动社区卫生服务的发展.方法 在北京市东城、西城、朝阳、石景山4个区,分别选取了1个社区卫生服务中心及中心下属的3个社区卫生服务站,对年满15岁的就诊患者发放社区卫生服务满意度问卷.问卷借鉴了澳大利亚皇家全科医学学会的满意度调查工具,共计对4 500名年满15岁的就诊患者进行调查,回收有效问卷4 223份.结果 患者对社区卫生服务的总满意率为96.6%,其中对"医生对您的尊重程度"的满意率最高为95.9%,而对"候诊室为儿童提供的设施"及"医生给儿童看病的能力"的满意率最较低,分别为37.7%和39.4%.结论 全科医生的医疗技术和服务态度是影响满意度的重要关联因素.     

病案信息在医疗保险中的作用

随着我国社会主义市场经济体制改革的深入,公费医疗逐步被医疗保险所取代,全国范围内的医疗保险已进入全面实施阶段.目前我国的医疗保险主要分为两种:社会基本医疗保险和商业医疗保险.在医保工作中,病案信息发挥着特殊而重要的作用;为参保者及核保兑赔提供原始资料;为险种的制订提供科学依据;为制订和调整单病种医疗保险费用标准提供依据;在医疗保险监督审核中的作用;在医疗质量监控中的作用;为医疗保险策部门测算分析、制定政策提供依据.