Table 1

Sociotechnical dimensions19

Hardware and softwareComputing infrastructure used to support and operate clinical applications and devices
Clinical contentThe text, numeric data and images that constitute the ‘language’ of clinical applications, including clinical decision support
Human–computer interfaceAll aspects of technology that users can see, touch or hear as they interact with it
PeopleEveryone who is involved with patient care and/or interacts in some way with healthcare delivery (including technology). This would include patients, clinicians and other healthcare personnel, IT developers and other IT personnel, informaticians
Workflow and communicationProcesses to ensure that patient care is carried out effectively, efficiently and safely
Internal organisational featuresPolicies, procedures, the physical work environment and the organisational culture that govern how the system is configured, who uses it and where and how it is used
External rules and regulationsFederal or state rules (eg, CMS's Physician Quality Reporting Initiative,20 HIPAA and Meaningful Use programme) and billing requirements that facilitate or constrain the other dimensions
Measurement and monitoringEvaluating both intended and unintended consequences through a variety of prospective and retrospective, quantitative and qualitative methods
  • HIPAA, Health Insurance Portability and Accountability Act of 1996; IT, information technology.