Question

Discuss mental models (user task environment, human-computer interaction, environmental issues) that may be influencing the human component of the e-prescription process in hospitals or clinics. And what is the reason for poor adoption of health information technology tools such as poor usability, variability in goals, identified care gap, lack of information at the right time, lack of care coordination, creation of workarounds in e-prescribing process?

Answer 1

Ans) Health information technology (HIT) has great potential to increase care quality, efficiency, and safety through its wide adoption and meaningful use. An example of the importance of this goal is that it is the major rationale behind the United States (US) national HIT Initiative, started by President Bush in 2004 and strengthened by President Obama in 2009 with the $19 billion HITECH Act under the American Recovery and Reinvestment Act (ARRA) to have every American's medical records on computers by 2014.

- However there are huge gaps between the status quo and the potential of HIT, mostly due to cognitive, financial, security/pri-vacy, technological, social/cultural, and workforce challenges.

- Among these, the 2009 National Research Council (NRC) report on " Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions " (Stead and Lin, 2009) identified " cognitive support " as an overarching research grand challenge for HIT. Cognitive support for HIT is intended to assist clinical problem solving and decision making such that the care for patients can be maximized along the Institute of Medicine's six dimensions of quality (safe, effective, timely, efficient, equitable , and responsive) (Institute of Medicine, 2001). Thus this chapter is devoted to exploring the methodologies of cognitive science as they are applied to more fully understanding the stresses of the clinical environment to aid in developing clinical decision support (CDS) to meet these needs. Much of the stresses come from the nature of health care itself, the burdens of the information and knowledge explosion , the multiplicity of diagnostic and therapeutic choices available, the time pressures , and the fragmentation of care, which led to the demand for CDS in the first place. The need to better understand cognitive considerations is especially true for more complex care, when the patients themselves are more complicated, multiple participants are involved in the health care team, and often the environments themselves are stressful – such as in the emergency department, operating room, or critical care unit. Decision Making in Healthcare funded by the Strategic Health Advanced Research Projects (SHARP) grant program under the Office of the National Coordinator for Health IT (ONC), characterizes the cognitive challenges for HIT as the gaps between HIT systems with good and poor cognitive support at three Levels. At the work domain level, HIT systems with good cogni-tive support should have an explicit, unified, accurate, and comprehensive model that reflects the true ontology of the work domain, which provides a clear understanding of the care that is independent of how systems are implemented.