More Research Needed to Prove That Designing Clinical IT Without Knowing What You're Doing May Have Unintended Consequences?

In the article "Design of Patient Tracking Tools May Have Unintended Consequences" excerpted below, researchers found that technology designed by technologists without adequate domain expertise, especially in complex domains such as hospital emergency departments (ED's), often does not work as expected. It can interfere with staff communications, for example - a potentially disastrous consequence in an ED environment where patients can be highly unstable.

A PI in the study observed that "the results provide an important case study of what can happen when new technologies are developed without sufficient understanding by designers of the nature of the work in which they will be used."

AHRQ has provided funding to develop simulations of proposed electronic patient tracking systems in order to better evaluate and match them to the needs of hospital emergency departments.

This raises several questions:

1. How many more case examples are needed to convince technologists that the finest "process" in the world, the world's finest generalists, and the most ingenious theories of "management mysticism" will not help in the quest for automated production of Mozart symphonies, or interplanetary travel via hot air balloon?

2. AHRQ has provided funding to fix a symptom , but not the disease. Where is the funding for further study and change of the attitudes and ideologies in the technology fields that cause real systems to be developed for healthcare (among other areas) that " are developed without sufficient understanding by designers of the nature of the work in which they will be used," such as CPOE systems designed for calm, solitary office environments , "appalling" EHR systems where vendor and subcontractors had not listened to end users , and ED virtual whiteboards that interfere with intra-staff communications?

-- SS

Design of Patient Tracking Tools May Have Unintended Consequences

Proper design of computational tools is critical if they are to be used with success in patient-care settings, particularly in hospital emergency rooms, a field study conducted by researchers at the University at Buffalo and other institutions recently revealed.

Newswise — Proper design of computational tools is critical if they are to be used with success in patient-care settings, particularly in hospital emergency rooms, a field study conducted by researchers at the University at Buffalo and other institutions recently revealed.

Nationwide, electronic patient tracking technologies are replacing traditional, dry-erase patient status boards, according to the UB researchers, who conducted the study with colleagues at the University of Rochester and the University of Florida, Jacksonville. The results were presented last month by the UB researchers at the annual meeting of the Human Factors and Ergonomics Society.

The researchers studied how new electronic patient-status boards were functioning in the emergency departments of two busy, university-affiliated hospitals. Overall, the UB researchers found that the computational tracking systems tended to affect how health-care providers communicate information and track activities regarding patient care, which can cause providers to change the way they work.

The results provide an important case study of what can happen when new technologies are developed without sufficient understanding by designers of the nature of the work in which they will be used, according to Ann Bisantz, Ph.D., associate professor of industrial and systems engineering in the UB School of Engineering and Applied Sciences, and a co-investigator on the study.

"Research in human factors, the study of the interactions between humans and technology, has shown that in complex workplaces where safety is critical, such mismatches between the way practitioners work and the technologies that are supposed to support them can have unintended consequences, including inefficiencies and workarounds, where the technology demands that people change their work method," said Bisantz.

... According to Bisantz, manual whiteboards perform a critical, central function for emergency departments, providing not just patient names and demographic information, but also a means for health-care workers to share information on patient complaints, vital signs, lab tests, consultations, dietary and allergy alerts, and notices about patient rooms that need to be cleaned.

The results revealed that the innate flexibility of the manual whiteboard allowed health-care providers and other emergency department staff to use it to communicate with one another ... "With a computerized system, providers have to find an available computer terminal and log-in," she said, noting: "The providers can't just walk up to the whiteboard and make a notation."

In some cases, providers noted that computer systems hid some of the information; if only three comments could be viewed per screen, they had to click to get to another screen, requiring them to search for information that might demand immediate attention. [A truly remarkable design flaw for an ED system - ed.]

... "If you don't understand the underlying structure of the work that is being done in a particular setting, then you cannot design the technology that will best support it," Bisantz said. [Doh! - ed.]

... The UB researchers have now received funding from the Agency for Healthcare Research and Quality (AHRQ) of the U.S. Department of Health and Human Services to develop simulations of proposed electronic patient tracking systems in order to better evaluate and match them to the needs of hospital emergency departments.