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credit attribution: The Global Health Delivery Project, GHDonline.org,
Sep 17, 2015.
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Added on 17 Sep 2015
Authors: Joaquín Blaya, PhD; Reviewed by Isabelle Celentano
Most experts agree that good design in health care delivery is lacking, including in health IT.1 Although it is difficult to evaluate the impact this has had, several studies show that poorly designed health IT systems can be harmful and can even increase medication errors.2 The U.S. Centers for Disease Control and Prevention (CDC) stated that many EMR problems impacting patients have roots in system design, specifically the lack of IT participation in design details prior to rollout.3 The American Medical Informatics Association (AMIA) also recognized the need for research into health IT-related human factors.4
With such an obvious need to pay closer attention to health IT design, this panel examined its role in effecting outcomes and ways to make improvements.
- Access to specific tools useful to users, such as online lab results, is a main driver for EMR adoption.5
- These tools must provide access to new capabilities or health data, like ePrescribing or discharge summaries, in better or faster ways.
- Health IT design must take into account the perspective of the patient and the health care professional.
- Economist and social scientist Herbert A. Simon said that for any group of people, the participation hypothesis states “...significant changes in human behavior can be brought about rapidly only if the persons who are expected to change, participate in deciding what the change shall be and how it shall be made.”
- Examples of participatory projects:
- The Youth Net Project, a program that gives young people in Brazil an opportunity to use GPS enabled mobile phones to map environmental risks in their communities. This information is then aggregated and displayed in a manner that engages stakeholders and decision makers.
- A similar use was recently applied in Haiti, where teenagers attempted to identify and document barriers to access to preventive services for HIV using mobile phones. This example yields very concrete results related to public health, equity (through the participation of vulnerable populations), social and environmental determinants of health, and ICTs.
- A primary challenge for designing health technologies in low-resource settings is understanding ongoing change in clinical processes–this creates gaps between the intended design of a system and the reality of the clinical environment.
- Simplicity is the key to great products, hence the KISS rule (Keep It Simple Stupid).
- There was the idea that similarity of interfaces would improve interoperability of medical records across health systems, but it seems that standardizing the underlying data would be a better route.
- The reality is that many of the data collection and tracking tasks are being done on paper; therefore we must also take these design approaches to paper forms and paper data collection methods.
- Real world examples include:
- Governance and architecture play important, but often neglected, roles in design, especially those at national scale.
- Both are risk-mitigating techniques. Although governance and architecture appear to limit design possibilities, they actually enable structured interactions between architecture-compliant designs. It could also be cost-effective if there is access to a common, shared repository of enterprise architecture artifacts that can be used as constraints for the national health information system design.
- Governance sets directions, so it is clear which way the program goes.
- Architecture constrains the artifacts, “forcing” apps to reuse these artifacts as much as possible.
- For example, Philippines governance structure
- Decoupling the data and presentation can create tailored user interfaces and give the end users the ability to choose the look of their page.
- Kvedar JC. Is Design Important In Healthcare? Healthcare IT News. May 13, 2013. Available at: http://www.healthcareitnews.com/blog/design-important-healthcare.
- Koppel R, Metlay JP, Cohen A, et al. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA. 2005;293(10):1197-1203. Available at: http://jama.jamanetwork.com/article.aspx?articleid=200498.
- Schuman E. CDC on EHR errors: Enough's enough. Healthcare IT News. July 8, 2014. Available at: http://www.healthcareitnews.com/news/cdc-ehr-errors-enoughs-enough.
- Middleton B, Bloomrosen M, Dente MA, et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc. 2013(0):1-7. Available at: http://jamia.oxfordjournals.org/content/20/e1/e2.long.
- Protti D, Bowden T. Electronic Medical Record Adoption in New Zealand Primary Care Physician Offices. The Commonwealth Fund, Issues In International Health Policy. 2010:1-13. Available at: http://www.commonwealthfund.org/~/media/Files/Publications/Issue Brief/2010/Aug/1434_Protti_electronic_med_record_adoption_New_Zealand_intl_brief.pdf.
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