port of an integrative view of patient data [C1O1]. Care providers had to flip among many screens and often among many systems to access data; in some cases, care providers found it easier to manage patient information printed or written on paper.

A reviewer of this report in draft form noted the non-intuitive behavior of most health care IT systems and the training requirements that result from that behavior. Hospitals often require 3- or 4-hour training sessions for physicians before they can get the user names and passwords for access to new clinical systems. Yet much of the computing software that these people use in other settings (e.g., office software) adopts a consistent interface metaphor across applications and adheres to prevailing design/interface norms. As a result, there is much less need for training, and the user manual need only be consulted when special questions arise. In contrast, health care IT lacks these characteristics of conventional software packages—a fact that reflects the failure of these systems to address some basic human interface considerations.

The committee also saw little cognitive support for data interpretation, planning, or collaboration. For example, even in situations where different members of the care team were physically gathered at the entrance to a patient’s room and looking at different aspects of a patient’s case on their individual computers, collaborative interactions took place via verbal discussion, not directly supported in any way by the computer systems, and the discussions were not captured back into the system or record (i.e., the valuable high-level abstractions and integration were neither supported nor retained for future use).

Instead, committee members repeatedly observed health care IT focused on individual transactions (e.g., medication X is given to the patient at 9:42 p.m., laboratory result Y is returned to the physician, and so on) and virtually no attention being paid to helping the clinician understand how the voluminous data collected could relate to the overall health care status of any individual patient. Care providers spent a great deal of time in electronically documenting what they did for patients [C1O3], but these providers often said that they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care.

These shortfalls are not necessarily for lack of investment; although health care organizations as a whole spend a relatively smaller percentage of their revenues on IT than do other fields such as banking,1 one organization—a major integrated health care enterprise with yearly rev-

1

David W. Bates, “The Quality Case for Information Technology in Healthcare,” BMC Medical Informatics and Decision Making 2:7, 2002, available at http://www.biomedcentral.com/1472-6947/2/7.



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