Computational Technology for Effective Health Care Immediate Steps and Strategic Directions (2009) / Chapter Skim
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Appendix C: Observations, Consequences, and Opportunities: The Site Visits of the Committee
Appendix C: Observations, Consequences, and Opportunities: The Site Visits of the Committee
Pages 93-104
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From page 93... ...
The health care delivery process -- the workflow, C what happens when, who does it, how decisions are made, how communication occurs. -- ategory 3.
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From page 94... ...
That is, why do we care about the observation in question? How might it affect health care delivery?
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From page 95... ...
2 Clinical user interfaces • Important • Design reflecting mimic their paper information and human and safety predecessors trends are easily factors (S) • The flow sheet is overlooked • Automatic capture and the predominant • Cognitive burden use of context (what, display construct of absorbing the who, when.
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From page 96... ...
Category 2. The Health Care Delivery Process 5 High complexity • Reactive care • Dynamically and coordination • Handoff errors computable models to requirements of care • Redundant care represent plan for care, • Within teams workflow, escalation, • Across teams and and so on (R)
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From page 97... ...
10 Clinical research • Difficulty deciding • Computable models activities not well what to charge to of research plan, integrated into ongoing whom for research or workflow, researcher clinical care care roles, etc.
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From page 98... ...
(S) user interface • Misinterpretation of information • System work arounds 13 Health professionals' • Health • Educate health understanding of professionals do not professionals in how IT might help is know what to ask systems approaches limited for • Imbed informatics • Health experts in clinical professionals do teams (as is done with not know how to pharmacists)
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From page 99... ...
(S) limited 15 Centralization • Does not support a • See Category 2, of management dynamic learning observations 5 and 6 and reduction in health care system (C2O5, C2O6)
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From page 100... ...
16 Implementation time • Requires • See observation 14 lines are long and investment far in (C4O14) course changes are advance of benefit expensive • Inconsistent with • Actual president's goal implementation for electronic time lines for medical records by enterprise-wide 2014 functionality commonly exceed a decade • New systems are being implemented while the previous generations are still being rolled out 17 Security and • Neither is effective • Techniques to privacy compete authenticate a patient to with workflow his/her record (S/R)
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From page 101... ...
(S/R) • See Category 1, observation 2 20 User interfaces do not • Systems intended to • Design reflecting reflect human factors reduce error create human and safety and safety design new errors factors (S)
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From page 102... ...
• Unit doses of medication are not manufactured with computer-readable tags 23 Semantic • Lack of • Interfaces that enable interoperability is interoperability entry of data in almost non-existent limits data and flexible ways, but that knowledge reuse guide the user into using common fields and terminologies in a non-obtrusive fashion (S/R) • Methods to reconcile multiple references to the same real-world entities (e.g., different ways of referring to penicillin)
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From page 103... ...
integrated into practice • Benefits are significantly less than anticipated • Reduced investment 25 Innovation requires • Limited innovation • Management that locally adaptable and standardization encourages initiation systems but of improvements by interoperability health professionals (S) and evidence-based • Technology and medicine require more processes that allow standardization local innovation and flexibility but foster collaboration and learning at a national scale (R)
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