Key Articles: Approaches to Studying the Effects of Health Information Technologies

Each of the special topic pages on EHR Science has a Key Articles section.   When selecting articles for these sections, I look for papers that provide fundamental insights of some type.  For example, they may be great introductions to a topic, provide a new technical insight, or offer a new method for analyzing a specific type of problem.   More often than not, I write a post about these papers before they are added to a Key Articles section.   However, as I add more topic pages, blogging about every article is becoming more difficult.  Even so, I still want you to know about them, and why I think they are worth reading.   With this in mind, I have decided to try a new type of post–today’s being the first– in which I briefly introduce 1-3 articles that can be found in one of the Key Articles sections.   Today, I would like to bring to your attention two papers that discuss HIT evaluation approaches.

Sociotechnical theory and HIT Evaluation
A New Sociotechnical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems, by Sittig  and Singh,  presents sociotechnical theory as a tool for evaluating HIT from design to implementation and final evaluation.   They offer an eight-dimensional model for assessing HIT.   The categories appear below.

Hardware and software computing infrastructure
Clinical content
Human-computer interface
Workflow and communication
Internal organizational policies, procedures, and culture
External roles, regulations and pressures
System measurement and monitoring

I chose this paper because the authors advocate a standard framework for HIT evaluation based on sociotechnical theory.    Should the authors continue this work, their framework, if widely adopted, could help to make studies of HIT more readily comparable.  This paper is certainly worthwhile reading for anyone interested in studying the effects of HIT.

Related papers
Meeks DW, Takian A, Sittig DF, Singh H, Barber N. Exploring the sociotechnical intersection of patient safety and electronic health record implementation. J Am Med Inform Assoc. 2013 Sep 19.

Sittig DF, Ash JS.  On the importance of using a multidimensional sociotechnical model to study health information technology. Ann Fam Med. 2011 Sep-Oct;9(5):390-1.

Process mining and HIT evaluation
Process mining uses information from event logs (e.g., EHR audit trail) to analyze processes.  The second paper, A Process-Oriented Methodology for Evaluating the Impact of IT: A Proposal and an Application in Healthcare, presents a detailed case study that uses process mining and simulation to study the effects of HIT in dentistry.    By combining process mining with discrete-event simulation, the authors demonstrate how these techniques can be used to evaluate HIT deployments.   While these techniques may be overkill in a typical outpatient setting, they could potentially make large-scale HIT deployments less prone to failure and easier to optimize.     I chose this paper because of the clarity with which it presents the rationale and methods for process mining in the context of a real-world scenario.

Process mining is not a common technique for analyzing HIT systems. However, with the increase in EHR adoption, process information, in the form of audit trails (required for MU), makes process mining a potentially useful tool in any healthcare setting.    Should EHR systems come to have workflow engines as standard features, process mining will become a valuable tool for evaluating productivity, efficiency, usability, and other issues related to EHR use.   This is not light reading, but it is worth the effort.

Both papers may be found on the Adoption and Implementation resources page.


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