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A new sociotechnical model for studying health information technology in complex adaptive healthcare systems
  1. Dean F Sittig1,
  2. Hardeep Singh2,3
  1. 1UT - Memorial Hermann Center for Healthcare Quality & Safety, University of Texas School of Biomedical Informatics at Houston, Texas, USA
  2. 2Houston VA Health Services Research and Development Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  3. 3The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, Michael E DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to Professor Dean F Sittig, UT—Memorial Hermann Center for Healthcare Quality & Safety, University of Texas School of Biomedical Informatics at Houston, 6410 Fannin St UTPB 1100.43, Houston, TX 77030, USA; dean.f.sittig{at}uth.tmc.edu

Abstract

Background Conceptual models have been developed to address challenges inherent in studying health information technology (HIT).

Method This manuscript introduces an eight-dimensional model specifically designed to address the sociotechnical challenges involved in design, development, implementation, use and evaluation of HIT within complex adaptive healthcare systems.

Discussion The eight dimensions are not independent, sequential or hierarchical, but rather are interdependent and inter-related concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the ‘language’ of clinical applications. The human–computer interface includes all aspects of the computer that users can see, touch or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end user, including potential patient-users. Workflow and communication are the processes or steps involved in ensuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organisational features (eg, policies, procedures and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.

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Footnotes

  • Funding This research was supported in part by the National Library of Medicine R01-LM006942, NIH K23 career development award (K23CA125585), the VA National Center of Patient Safety, Agency for Health Care Research and Quality and in part by the Houston VA HSR&D Center of Excellence (HFP90-020).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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