First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety

[Excerpt] This book is an exploration of why patient safety is advancing at what seems to be an almost glacial pace, despite the often vast and determined efforts of health care workers and managers. A collection of essays from prominent researchers, scholars, and even patients, this book aims to identify some of the gaps in the patient safety movement, the disconnected dots that do not coalesce despite decades of hard work and billions of dollars. It also identifies concerns that have not been integrated into the patient safety discourse or agenda of more established groups

Computerized Physician Order Entry Systems: The Right Prescription?

Policymakers increasingly urge the use of information technology to improve the quality and efficiency of health care. In particular, computerized physician order entry (CPOE) is emphasized for its ability to reduce prescribing errors inherent in paper-based systems. This Issue Brief summarizes research that sounds a cautionary note about the potential for computerized systems to facilitate medication errors, as well as reduce them

A Comparison Of Video Formats For Online Teaching

The use of video to deliver content to students online has become increasingly popular.  However, educators are often plagued with the question of which format to use to deliver asynchronous video material.  Whether it is a College or University committing to a common video format or an individual instructor selecting the method that works best for his or her course, this research presents a comparison of various video formats that can be applied to online education and provides guidance in which one to select

Healthcare Information Technology’s Relativity Challenges: Distortions Created by Patients’ Physical Reality versus Clinicians’ Mental Models and Healthcare Electronic Records

This paper examines the inconsistencies or distortions among three medical realities: patients’ physical reality (as reflected in clinical observations, lab reports, and other “objective” measures); clinicians’ mental models of patients’ conditions; and how that information is represented in the patient’s electronic chart—the electronic health record (EHR). We created a typology based on the semiotic triangle of “symbol,” “thought or reference,” and “referent.”Differing perspectives (or realities) are illustrated with examples from our observations in hospitals and medical facilities, interviews with clinicians, IT personnel and IT vendors, computer logs, and error reports.Scenarios/models enumerate how the differing perspectives can misalign to produce distortions in comprehension and treatment. These are categorized according to an emergent typology derived from the cases themselves and refined based on insights gained from the literature on interactive sociotechnical systems analysis, decision support science, and human-computer interaction.The scenarios reflect the misalignment between patients’ physical realities, clinicians’ mental models, and EHRs, identifying five types of misrepresentation: IT data too narrowly focused; IT data too broadly focused; EHRs miss critical reality; data multiplicities—perhaps contradictory or confusing; distortions from data reflected back and forth across users, sensors, and others.Conclusion: With humans, there is a physical reality and actors’ mental models of that reality. In healthcare, there is another player: the EHR/healthcare IT, which implicitly and explicitly reflects many mental models, facets of reality, and measures thereof that vary in reliability and consistency. EHRs are both microcosms and shapers of medical care