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

110 W.H. Drummond et al.
and human social nuances. For example teaching a computer to process the query
“Did you start the vancomycin before or after you talked to the surgeons?,” can
75, 76
require very complex processing, even when not occurring in real-time.
8.3.5.9 Clinical Trends
Tracking changes over time is a very important component of clinical decision
making in Pediatrics. Decisions concerning conservative treatment versus surgery
(i.e. for premature patent ductus arteriosus), discharge prediction (e.g. for funding
and planning purposes), and ultimate outcome prediction (i.e. speed of normalization
of brain function after a perinatal hypoxemic/ischemic episode), all require
temporal reasoning. 74, 75 Existing information systems for “charting” and “ordering”
have limited capabilities of recording time elements. For example, in expressing
plans for follow-up, some systems provide “month” with only a single character
to list a time (the provider might want to choose days or more than 9 months for a
follow up appointment). Some systems require a duration unanchored to a beginning
or ending date and time point (e.g. elapsed minutes of chest compression during
resuscitation efforts). Many archival hospital databases do not have provisions
for inclusion of multiple, sequential occurrences of the same procedure or disease
(e.g. sequential fetal and cranial ultrasounds, sepsis and suspected sepsis episodes,
x-rays, and serial eye exams).
8.3.6 General Discussion
Lessons from avionics, nuclear power plants, and military subsystems on battleships
underscore the importance of socio-technical factors in safe system implementation.
The medical literature has reinforced these lessons through a series
of well respected articles by Leape. 25, 51, 52, 79, 80 Brilliant, single situation “systems
analyses” 2, 7–9, 23, 72 provide examples of the complex interaction between human
factors and technology at every level in healthcare. 67
The growing literature dissecting past HIT errors should serve as a warning
beacon to reorient planning for a HIT implementation to consider ergonomics,
human factors, and time-sensitive workflow processes that healthcare computerization
may change. While technology holds tremendous promise, it has also proven
its excellent capacity to interrupt processes, disable communication, increase burden
to providers and potentially worsen existing conditions unexpectedly. Research
in human factors must be refocused on the healthcare industry. System designers
must adopt the same strict controls that have been defined around overall aviation
safety by the FAA and around the development and assurance testing of computerized
medical devices by the FDA.
Dissecting complicated health IT problems requires a multidisciplinary team of
experts (Table 8.4). This team must be adept at identifying potential failure modes