IMPLEMENTATION AND USE OF TECHNOLOGIES

Evaluations of how safely health technologies are implemented and used will help build safer systems. There is a need to build a larger body of evidence that identifies the most successful implementation methods as well as to study and measure actual use of health IT. An area of particular concern also underrepresented in the literature is use of patient engagement tools.

To identify successful implementation methods, sharing of common experiences can help create guidance specific to the acquisition and initial implementation of health IT. For example, is the best method of implementing health IT to take a “big bang” approach where all divisions of an organization adopt a health IT product at the same time, or is it to roll out the product incrementally? Evidence for the best method to back up an EHR in case of unforeseen downtime and other types of contingency plans would help reduce the risks of making mistakes and thereby improve the overall system safety.

Further investigations will also be needed about how health IT products are actually being introduced and integrated into clinical workflows. Currently, data on the impact of health IT on workflows are sparse and largely anecdotal. Examining disruption of workflow can reveal where health IT design poorly matches the incentives and demands clinicians encounter during work, generating knowledge about the generic and specific nature of problems. Obstacles to sharing experiences gained during implementation include that providers are too busy to document what happened to them, and that experiences across both large and small medical service organizations are needed. Facilitating the lessons learned may require additional resources from a public source. Specific measures of usability that apply across clinicians and settings would help speed adoption. Assessments made after clinical implementation of health IT can evaluate whether or not it is working as designed as well as the presence of adverse events. Detailed measures will be needed to assess the actual performance of any life-critical technology. For example, measures on how well the technology has been implemented in the clinical setting could monitor whether a technology is being used safely and is not inadvertently introducing risks into the clinical workflow. Exploring the safety consequences of work-as-designed compared to work-as-practiced at the front lines of care delivery is crucial. For example, the Adverse Event Reporting System has been of great value in understanding the practical risks of drug administration.

Another critically important area for research is effective flow of information to both providers and patients. In an age where the average patient record weighs seven pounds, research is needed on summarization, saliency, and understanding to capture the nonlinear nature of the health care work



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