A second reason for the complexity of systems involving health IT is the large number of interacting actors who must work effectively with the information. For example, the provision of health care requires primary care physicians, nurses, physician and nurse specialists, physician extenders, health care payers, administrators, and allied health professionals, many of whom work in both inpatient and outpatient settings.
The IT needed to store, manage, analyze, and display large amounts of heterogeneous information for a wide variety and number of users is necessarily complex. Put differently, the complexity of health IT fundamentally reflects the complexity of medicine. Safety issues in health IT are largely driven by that complexity and the failure to proactively take appropriate systems-based action at all stages of the design, development, deployment, and operation of health IT.
The sociotechnical perspective takes the approach that the system is more than just the technology delivered to the user. The overall system—the sociotechnical system—consists of many components whose interaction with each other produces or accounts for the system’s behavior (Fox, 1995). A sociotechnical view of health IT-assisted care might be depicted as in Figure 3-1.
For purposes of this report, the components of any sociotechnical system include the following:
• Technology includes the hardware and software of health IT, which are organized and developed under an architecture that specifies and delivers the functionality required from different parts of health IT, as well as how these different parts interact with each other. From the perspective of health professionals, technology can also include more clinically based information (e.g., order sets), although technologists regard order sets as the responsibility of clinical experts.
• People relates to individuals working within the entire socio- technical system and includes their knowledge and skills regarding both clinical work and technology as well as their cognitive capabilities such as memory, inferential strategies, and knowledge. The “people” component also includes the implementation teams that configure and support the technology and those who train clinical users. People are affected by technology—for example, the use of health IT may affect clinician cognition by changing and shaping how clinicians obtain, organize, and reason with