Enrico Coiera

What’s the research –
Using computers and other devices in healthcare has helped us work faster, improve memory recall and take away the repetitive record-keeping tasks. In embracing technology we did not think we would be making new and sometimes serious errors causing patient harm. Understanding the interplay between people, clinical workflow and use of technology needs urgent attention.

Why it’s important –
Patient harm caused by the disconnect between clinical work and poorly designed clinical systems is real. Tell-tale signs of this occurs when clinicians look for workarounds, use cut and paste features; or opt to bypass the system entirely thus creating parallel workflows. Current generation clinical IT systems are designed with the implicit assumption that clinicians are carrying out a single task and that their attention is devoted entirely to that task. Reality-check: clinicians multi-task, are constantly interrupted while in the middle of writing up a clinical note or medication order. If only computers could anticipate the highly distracted environment in which clinicians work and could support then in recovering from where they left off. Training, training and more training is not the solution. Rather than design IT systems to match complex ways of working, why not design them to decrease complexity and cognitive overload?

What have we learned –
Clinical information systems need to be designed with the user and their fast paced, interruptive environment in mind. If we ignore the user then incorrect assumptions are made about the patient care settings and systems are poorly designed and tend to add to complexity and workload. This is what creates new sources of error. EMR systems implemented today, were designed many years ago. In delegating tasks to the EMR, clinicians cannot shed responsibility for tasks performed even where the computer is doing most of the task. Accountability always sits with the clinician (can’t blame the computer). You cannot train for automation bias. Accountability for consequences of decisions is the only way to reduce this type of error. There is an imperative to design clinical information systems that are both safe in construction and in use. IT implementation is not a technical process, it is about fitting IT to users and their workflow- implementation is redesign and optimisation of existing clinical processes.

Who should read this paper –
Vendors, procurement teams, implementation teams, change managers stand to attention because the increasing use of IT in health has become a new source of patient harm. User-centred design and user experience is emerging as a hot topic. Ensure you have this expertise on your teams or request evidence that such rigor has been invested in system design.

To read the entire journal article, click here.

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Patient harm caused by the disconnect between clinical work and poorly designed clinical systems is real.