create new paths to ADEs (Patterson et al., 2002; Patterson, 2003). The information display of the systems is much like that of other decision-support systems that rely on computer-based monitors and graphical interfaces. Specific issues with interface design vary depending on the vendor, but generally relate to the incompleteness of the medication information displayed and its effect on clinical coordination (Cipriano, 2003; Patterson, 2003). For example, the more inflexible systems require a long, confusing sequence of programming activities for a simple change to medication administration times. Moreover, important medication information is either not available or not displayed in a timely manner. Key problems identified include (1) pending and discontinued medication orders not displayed; (2) inability to document medications not displayed as administered when they had been administered; (3) automated removal of medications from bar code medication administration systems, resulting in confusion; (4) inability to view changes to medication orders without opening a patient record; (5) difficulty of undoing actions: (6) difficulty of revising database information once entered; and (7) poorly organized data screens, resulting in missed medications (Patterson et al., 2002; Rogers et al., 2005). The fragmentation of patient data also contributes to clinicians’ inability to obtain at a glance a comprehensive overview of patients’ medication information, as well as to degraded coordination between physicians and nurses—one of the more noted negative side effects of bar code medication administration systems (Patterson et al., 2002).

Efforts in the United Kingdom have started to address user interface issues through an agreement with Microsoft Corporation. Microsoft will develop a health-specific user interface for clinical systems used by the National Health Service to improve patient care and safety. Under the terms of the agreement, Microsoft will supply code based on the full shipping versions of its desktop software that can be used by independent vendors and supply customized versions of Office and Windows (NHS, 2004). However, use of common coding to link and present data is only one aspect of improving the user interface.

Addressing user interface issues will require greater attention to the cognitive and social factors influencing clinicians in their daily workflow and interaction with technologies (van Bemmel and Musen, 1997). Yet little emphasis has been placed on physicians’ ability to learn and use these systems or on the technologies’ effects on physicians’ reasoning. From the perspective of cognitive psychology, designers must develop a better understanding of how clinicians best comprehend information, as well as of the limits of human perception and memory. The context of the clinical environment, in which clinicians must perform multiple tasks simultaneously and manage numerous interruptions by beepers, telephones, and colleagues,



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