The social act of electronic medication prescribing

__Abstract__ Prescribing medication is embedded in social norms and cultures. In modern Western health care professionals and policy makers have attempted to rationalize medicine by addressing cost-effectiveness of diagnostic and therapeutic treatments and the development of guidelines and protocols based on the outcomes of clinical studies. These notions of cost-effectiveness and evidence-based medicine have also been embedded in technology such as electronic prescribing systems. Such constraining systems may clash with the reality of clinical practice, where formal boundaries of responsibility and authorization are often blurred. Such systems may therefore even impede patient care. Medication is seen as the essence of medical practice. Prescribing is a social act. In a hospital medications may be aimed at treating a patient for a specific condition, in primary care the professional often meets the patient with her or his social and cultural notions of a health problem. The author argues that the design and implementation of electronic prescribing systems should address the social and cultural context of prescribing. Especially in primary care, where health problems are often ill defined and evidence-based medicine guidelines do not always work as intended, studies need to take into account the sociotechnical character of electronic prescribing systems

Understanding Implementation: a sociotechnical appraisal of the introduction of computerized physician order entry systems in Dutch and American hospitals

"Developing a comprehensive medical information system was a more complex task than putting a man on the moon had been", wrote the eminent medical informatics scholar Morris Collen in 1995. This thesis describes and analyzes the implementation of computerized order entry systems in Dutch and American hospitals. The case studies show how difficult it is to get such systems to work in clinical practice. How such systems can be implemented requires a thorough understanding of medical work practices. The author concludes that formal implementation procedures have limited value and that the successful implementation requires time and a great deal of improvisation. This will allow the prospective user to get acquainted with the system and improve her clinical practice through the opportunities provided by the system. In short, implementing a clinical information system is a thoroughly social process

The potential of real-time analytics to improve care for mechanically ventilated patients in the intensive care unit

__Background:__ Mechanical ventilation services are an important driver of the high costs of intensive care. An optimal interaction between a patient and a ventilator is therefore paramount. Suboptimal interaction is present when patients repeatedly demand,

Context Sensitive Health Informatics: Concepts, Methods and Tools

__Abstract__ Context is a key consideration when designing and evaluating health information technology (HIT) and cannot be overstated. Unintended consequences are common post HIT implementation and even well designed technology may not achieve desired outcomes because of contextual issues. While context should be considered in the design and evaluation of health information systems (HISs) there is a shortcoming of empirical research on contextual aspects of HIT. This conference integrates the sociotechnical and Human-Centered-Design (HCD) approaches and showcases current research on context sensitive health informatics. The papers and presentations outlines theories and models for studying contextual issues and insights on how we can better design HIT to accommodate different healthcare contexts

Economic evaluations of big data analytics for clinical decision-making

__Objective:__ Much has been invested in big data analytics to improve health and reduce costs. However, it is unknown whether these investments have achieved the desired goals. We performed a scoping review to determine the health and economic impact of big data analytics for clinical decision-making. __Materials and Methods:__ We searched Medline, Embase, Web of Science and the National Health Services Economic Evaluations Database for relevant articles. We included peer-reviewed papers that report the health economic impact of analytics that assist clinical decision-making. We extracted the economic methods and estimated impact and also assessed the quality of the methods used. In addition, we estimated how many studies assessed “big data analytics” based on a broad definition of this term. __Results:__ The search yielded 12 133 papers but only 71 studies fulfilled all eligibi

Towards safe information technology in health care

Health information technology is widely accepted to increase patient safety and reduce medical errors. The widespread implementation makes evident that health information technology has become of a complex sociotechnical system that is health care. Design and implementation may result in a failure; even health information technology can lead to adverse events instead of mitigating them. In this chapter seeks to outline the complexity of health information technology as a part of a sociotechnical systems, describes two failures at different organizational levels and presents a model how risks can occur. Unfortunately there is a mainly anecdotal knowledge about health information technology failure and potential adverse effects. Therefore the author suggests how as a first step proper and mandatory reporting can lead to better knowledge of failures of health information technology as part of a sociotechnical system and improve deployment in the coming years

Protecting Patient Privacy in Cyber Environments

Confidentiality in the medical encounter is crucial to providing adequate patient care. Health data is therefore privileged and protected by legal mechanisms. Health systems use electronic records and large-scale databases. Increasingly consumers use also IT to collect, store and share data about daily life and health behaviors. Sharing data via network-based systems or storing it ‘in the cloud’ produces multiple ‘digital selves,’ health ‘data doubles’ and ‘virtual patients.’ With so many stakeholders involved much data is produced without clear governance structures, blurring the view of what is done with the data. These problems are exacerbated through the networked, distributed nature of health data collection and convergence of protected hospital systems, commercial collection and aggregation of data and consumer health technologies. This brings patient privacy into the realm of cybersecurity. This panel explores how cybersecurity impacts the governance of critical IT infrastructures and mitigation of threats, what sociotechnical challenges are related to protection of large-scale HIT systems, how surveillance and bioethics studies seek to understand threats to personal privacy in the context of networked technologies and finally what changes to laws and regulations would be required