work necessarily involves social scientists who understand real human needs and capabilities, why people err, where workload considerations are essential, and how to develop systems that enhance capabilities, that are understandable with minimal training, and that reduce subsidiary task requirements. The use of health care IT designed in the absence of such input may well lead to greater errors, more stress, and lower productivity.3 In short, success requires not just technology but also—and perhaps more importantly—social and organizational processes to appropriately take advantage of technology.

4.1.5
Principle 5: Support the Cognitive Functions of All Caregivers, Including Health Professionals, Patients, and Their Families

Organizations investing in health care IT can support the cognitive functions of individuals and organizations as they iteratively adapt roles and work processes. Such support includes analysis of data from practice to identify high-priority improvement opportunities among populations or work processes, analysis of applicable evidence, tools such as order sets for linking evidence into workflow, and aggregation of patient data into decision-centric displays. Importantly, cognitive support needs tend to center on high-level decision making (e.g., diagnosis) for populations, patients, or situations, and tend to span granular transactional tasks such as test ordering or prescribing. Cognitive support is not well served by the task-specific automation systems that make up the majority of today’s health care IT.

4.2
RADICAL CHANGE

4.2.1
Principle 6: Architect Information and Workflow Systems to Accommodate Disruptive Change

Organizations should architect health care IT for flexibility to support disruptive change rather than to optimize today’s ideas about health care. It is axiomatic that health care will change dramatically into the future. New knowledge will become available—e.g., genomic medicine. Population demographics will change—e.g., more people will be elderly, with a correspondingly different emphasis on different kinds of care. Care ven-

3

See, for example, Yong Y. Han et al., “Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System,” Pediatrics 116(6):1506-1512, December 2005; also, Ross Koppel et al., “Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors,” Journal of the American Medical Association 293(10):1197-1203, 2005.



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