orders are being entered so that clinicians do not have to “click through” multiple alerts after order entry? Can health IT track the presentation of alerts to specific clinicians so that alerts appear when medicines or conditions new to that clinician appear?

The cooperative work problem: Health IT typically treats activities as belonging to individual clinicians and as being accomplished serially, but clinicians often work in tandem or in small groups and communicate with each other about goals and task details. How can health IT be designed and configured to assist cooperative work?

The accountability and reimbursement problem: Health IT often incorporates features that serve accounting and reimbursement functions. Large parts of the clinical record are being generated to conform to billing requirements or to provide a stream of accountability information for later review. These functions are valuable but do not directly aid the clinical process and can make clinical care more difficult by demanding attention and hiding meaningful data with bureaucratic camouflage. What are the consequences for clinical care of including all these functions in health IT designs? Can health IT be configured to encourage recording of high- quality clinical observations rather than just the accumulation of clinically meaningless filler?

The availability problem: The benefits of health IT are often touted by vendors and chief information officers but outages are nearly always accompanied by statements that “no patient was harmed” by the computer breakdown. These characterizations are seemingly in conflict. What is the real impact of system outages? How often does this occur? How can the effects be determined?

The interoperability at the user level problem: Each health IT vendor has its own “look and feel” and individual implementations are customized so that each facility has unique features. Many health professionals work in more than one facility and encounter these different products on a regular basis. Is it possible to make health IT interoperable at the user level so that clinicians moving from one facility to another do not have to learn a new way of doing things each time? Can systems be designed so that clinician profiles developed in one system can be used in another? What are the consequences of having every implementation be different from every other implementation?

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement