Pediatric Informatics: Computer Applications in Child Health (Health ...

92 W.H. Drummond et al.
noise overload conditions. Novel, random intermittent noises inhibit efficiency in
most tasks, especially complex ones, where vigilance, multitasking, and judgmental
sorting performance are required and interruptions are frequent. 32–35
8.2.3.3 Human Factors: Social Environment and Individual
Psychology
Poorly designed and implemented Health IT systems may add to the high cognitive
burden of pediatric intensive care unit providers, including distraction and physical
absence from the bedside. 23–24
Documentation of clinical care in health IT systems is often cumbersome and
may require up to 40% more time than paper systems. 36 Health IT systems that have
poor response times, frequent outages and cause interruptions in workflow (for
example by forcing providers to leave the bedside or carespace to document) have
been recognized as problematic. Computer screens that can be viewed by visitors
from neighboring bed spaces in crowded ICUs result in the loss of privacy.
Caregiver interactions with Health IT systems are currently designed to be
performed with one clinician paying full attention to one computer. The constant
interruptions in a medical environment make this use design realistically impossible.
36, 37 Interruptions take a special toll on care tasks that require undivided attention
to manage complex mental processes (i.e. managing fluids, calculations, drug
infusions and complicated treatment devices like ECMO or computerized ventilators),
or complicated human situations such as confronting the death of a patient,
and comforting the parents as a baby dies.
Successful implementation of Health IT in critical care environments requires
participation of clinical users in design, implementation, evaluation, and management.
Without participation and buy-in (including from night, weekend, and holiday shift
workers), information technology efforts in ICUs are usually viewed as time- consuming,
distracting, and without obvious direct benefit to the care staff, or their patients.
Additional challenges for pediatric providers include the disenfranchisement of
Pediatric patients in device and IT system development. Devices, workflow support
and software products that are appropriate for the Pediatric subgroups, if they
exist, are usually more expensive than for the adults. While drug manufacturers are
federally incentivized to test new medications on pediatric populations, the same
is not true for devices and software applications. For a variety of reasons including
cost savings, institutions may thus elect to implement devices and computer
systems designed and tested only for adults, potentially resulting in adverse events
and dangerous conditions in children.
8.2.4 Summary
Changes in difficult, complex, and fast-paced “safety critical” environments such as
ICUs, including computerization, must be handled carefully. Team-based preliminary