Usability is one characteristic of health IT design and development requiring further research. Maximizing usability will ensure clinicians’ needs are taken into account in the design of the relevant human-computer interactions. A variety of industry standards may apply to health IT but compliance with standards serves only as a weak screen for design deficiencies. Although general principles of usability are well described and some work around usability is currently under way in health IT, additional research is needed specifically about its impact on patient safety.

Another characteristic of design and development important to safety is interoperability. Interoperability can allow data to be shared readily, for example, between an electronic health record (EHR) and a pharmacy system without loss of semantic content. Interoperability will require harmonization of standards, such as how data can best be formatted and stored. Consistent rules governing transmission of data and use of common terminologies are being developed through health information exchanges; their success will need further inquiry.

Research is needed on interfaces to support the fact that medical care requires the cooperation of multiple health professionals in multiple institutions. The exchange of information between users, collaborative decision making, and the support of complex safety-critical processes will be critical to ensuring health IT operates as expected in health care settings. Unlike some of the other areas where such research is conducted (such as nuclear power plant operations and flying airplanes), medical applications have an additional complexity in that health professionals are treating multiple patients over the same time period and do not have the opportunity to land and finish one flight before having to think about the next one. Interfaces that support this “context switching” are essential, and not enough is known about them.

Also important to safe design and development of technologies is a better understanding of the tradeoffs between standardization and customization of health IT. While many users would like to modify health IT to fit their specific needs and health care environments, customization can make systems difficult to analyze. Customization can also prevent development of widespread solutions. On the other hand, health IT products that are too standardized may not appropriately fit into an organization’s workflow. A similar argument is considered in our policy discussion about the tension between regulation and innovation. Rigorous scientific evidence ought to serve as the basis to achieve a balance between making things the same and letting them differ. Similarly, research is needed to address the mismatch between the assumptions of health IT designers and the actual clinical work environment.

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