Health information technology: Fallacies and sober realities

Department of Industrial and Systems Engineering and Systems Engineering Initiative for Patient Safety, University of Wisconsin, Madison, Wisconsin 53706, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 11/2010; 17(6):617-23. DOI: 10.1136/jamia.2010.005637
Source: PubMed


Current research suggests that the rate of adoption of health information technology (HIT) is low, and that HIT may not have the touted beneficial effects on quality of care or costs. The twin issues of the failure of HIT adoption and of HIT efficacy stem primarily from a series of fallacies about HIT. We discuss 12 HIT fallacies and their implications for design and implementation. These fallacies must be understood and addressed for HIT to yield better results. Foundational cognitive and human factors engineering research and development are essential to better inform HIT development, deployment, and use.

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Available from: Robert Wears, Mar 20, 2014
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    • "Cases of fatal insulin overdose as a result of mix-up in the bar-coded wristbands [17], dehumanization as providers focused computer screens in lieu of their critically ill-patients [18], incorrect medications chosen from computerized pick lists [19], and most awful, escalation of paediatric mortality subsequent to computerized system [18]. Furthermore, researchers have reported that sites where CPOE were implemented still experience high rates of medication errors and adverse drug events (ADEs) [20], errors related to entry, retrieval, communication and coordination of health information [21] and low adoption rate of HIT [22]. Of particular importance in this study is the fact that healthcare providers who are satisfied with their careers are more likely to stay in their practice and hence, care continuity is assured and care delivery enhanced. "
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    ABSTRACT: Background: Nigeria is witnessing continuing advocacy and increase in number of individuals yearning for computerization of health information and healthcare processes. On the other hand, the Government of this most populous black nation is evolving plans and strategies for the adoption and implementation of health information technology (HIT). However, little is known about opinions of the diverse healthcare providers who would act the script of government in ensuring meaningful use of HIT in the country. Objective: This nationwide, cross-sectional study attempted to determine stakeholders’ perspectives of the emerging HIT in Nigeria. Result: HIT stakeholders who gave consent (n=233) at the two conferences participated in the study, 76% of whom were male professionals, mostly (117, 50.2%) from tertiary healthcare institutions. It worthy of note that three of the participants came from United States of America to attend the 1st National Conference on Health Information Technology in Nigeria. Of all participants, the majority (226, 99.1%) opined that HIT will improve communication among healthcare providers. A similar portion (223, 98.2%) were of the opinion that HIT will facilitate prompt retrieval of patient’s health records on point-of-care (POC). Nearly two-third (139, 62.6%) were optimistic of possible realization of nationwide implementations of HIT in the country by the year 2020. The results also indicate that gender, professional inclination, and place of work were important predictors of positive opinion of HIT. The three factors were associated with stakeholders’ opinion that the evolving HIT is capable of improving medical care quality (p=0.059; 0.000; 0.014) of the Nigerian populace. Most stakeholders (61%) recommended that the paper-based health records should be archived post implementation of HIT. Conclusion: The Nigerian healthcare system is manned by providers and stakeholders who are quite abreast of the benefits of health information technology and are willing to embrace the technology in their workflow. This is quite reassuring and tends to prompt the healthcare decision makers to proactively formulate policies and introduce interventions to encourage nationwide acceptance of the emerging technology. Nonetheless, there is more to be done on appropriate clinical documentation in order to set a friendly pedestal for effective takeoff, successful implementations and meaningful use. Appropriate funding and financial incentives for quality improvement is recommended. In addition, the National Conference on HIT should be convened annually and a technical committee be set up to appraise future implementations. Keywords: Computerized Physician Order Entry, Decision Support Systems, Electronic Health Records, Health Informatics, Health Information Management, Health Information Technology, Interoperability, Meaningful Use
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    • "Research has also accentuated the role of informatisation as being a facilitator of innovation and development, and one of the most important factors for improved interaction and more coordinated action between the stakeholders. The actual success of BM informatisation largely depends on the quality of ICT management and the integration of ICTs with business processes in the organisation (Pateli & Giaglis 2005; Nyamtema 2010; Karsh et al. 2010). Despite being the focus of substantial attention by academic researchers and practitioners in the last 15 years (Zott, Amit & Massa 2010), BM research has failed to establish a common or widely accepted theory-based framework. "
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    ABSTRACT: The Slovenian healthcare business model (BM) has largely failed to integrate information and communication technologies (ICT) into its operational context, instead maintaining its rigid structure and traditional 'way of doing business'wo managers of public clinics). Findings present a roadmap for the redefinition of BM elements and the transformation of the Slovenian healthcare BM. It includes the specific reconfiguration of BM actors and their interactions, and the application of advanced ICT solutions, which could facilitate more effective utilisation of healthcare resources and promote an improved delivery of healthcare services and products. The presented development approach and derived conceptual solution could be transferable to other countries with similar socio-economic characteristics and comparable healthcare systems, subject to certain adjustments and inclusion of national specifics.
    The HIM journal 11/2014; 44(2). DOI:10.12826/18333575.2014.0015.Stanimirovic · 1.15 Impact Factor
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    • "Medication errors have been identified at all stages of medication prescribing, administration, and monitoring in both in-and outpatient settings (Kaushal et al., 2001; Gurwitz et al., 2003; Koppel et al., 2005; Patterson et al., 2006; Bates 2009). New technologies may reduce errors and enhance patient safety but, if improperly designed, they can have negative unintended consequences on efficiency and safety (Koppel, 2008; Karsh, 2010). For example, Nebecker et al. (2005) found an adverse drug events (ADEs) incidence density of 70 ADEs per 1000 patient days; 86% of the reviewed ADEs may have been caused by recently implemented health information technologies. "
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    ABSTRACT: The Office of the National Coordinator for Health Information Technology (ONC) has been tasked with managing the integration of usability best practices into electronic health record development but, has provided little guidance on how to conduct Summative Usability Testing (SUT). We reviewed three aspects of SUT in four publicly available SUT vendor reports. Significant deviations from human factors engineering (HFE) and user-centered design (UCD) best practices and clear methodological errors were found in all four reports. The main sources of variation involved non-representative participant selection, instructions that led participant performance, and varied interpretation of results reporting requirements. Although ONC has made significant gains in implementing best practice UCD approaches, more explicit guidance may be needed to enhance integrity and reduce variation.
    10/2014; 58(1):1491-1495. DOI:10.1177/1541931214581311
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