Health Informatics J - Sources of variation in primary care clinical workflow: implications for the design of cognitive support.

Tópicos

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Resumo

This article identifies sources of variation in clinical workflow and implications for the design and implementation of electronic clinical decision support. Sources of variation in workflow were identified via rapid ethnographic observation, focus groups, and interviews across a total of eight medical centers in both the Veterans Health Administration and academic medical centers nationally regarded as leaders in developing and using clinical decision support. Data were reviewed for types of variability within the social and technical subsystems and the external environment as described in the sociotechnical systems theory. Two researchers independently identified examples of variation and their sources, and then met with each other to discuss them until consensus was reached. Sources of variation were categorized as environmental (clinic staffing and clinic pace), social (perception of health information technology and real-time use with patients), or technical (computer access and information access). Examples of sources of variation within each of the categories are described and discussed in terms of impact on clinical workflow. As technologies are implemented, barriers to use become visible over time as users struggle to adapt workflow and work practices to accommodate new technologies. Each source of variability identified has implications for the effective design and implementation of useful health information technology. Accommodating moderate variability in workflow is anticipated to avoid brittle and inflexible workflow designs, while also avoiding unnecessary complexity for implementers and users.

Resumo Limpo

articl identifi sourc variat clinic workflow implic design implement electron clinic decis support sourc variat workflow identifi via rapid ethnograph observ focus group interview across total eight medic center veteran health administr academ medic center nation regard leader develop use clinic decis support data review type variabl within social technic subsystem extern environ describ sociotechn system theori two research independ identifi exampl variat sourc met discuss consensus reach sourc variat categor environment clinic staf clinic pace social percept health inform technolog realtim use patient technic comput access inform access exampl sourc variat within categori describ discuss term impact clinic workflow technolog implement barrier use becom visibl time user struggl adapt workflow work practic accommod new technolog sourc variabl identifi implic effect design implement use health inform technolog accommod moder variabl workflow anticip avoid brittl inflex workflow design also avoid unnecessari complex implement user

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