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

8 Complexity in Healthcare Information Technology Systems 111
Table 8.4 HIT implementation – required team member experiences
Experiences required
Medical informatics
Nursing informatics
Clinical care delivery in intensive care units (doctors and nurses)
Clinical and regulatory compliance and education
Marketing, business development and contracting
New information technology introduction
Healthcare enterprise change management
Software/electrical engineering
User-focused design of software architectures databases, and programs
Financial and strategic planning
early in the functional design process and actively create installation, software,
and human system strategies that enhance safety and minimize risk. Dr. Reason’s
model for human error 81 explains: “The most important distinguishing feature of
high reliability organizations is their collective preoccupation with the possibility
of failure. They continually rehearse familiar scenarios of failure and strive hard to
imagine novel ones.” Although difficult to maintain, preoccupation with failure is
what distinguishes safe system implementations from tragic scenarios. In Pediatric
Informatics, it is essential that we learn from each other’s mistakes. Han’s courage
in reporting the system failures that occurred in Pittsburgh has helped countless
other institutions that are struggling through complex system implementations.
Safety is best achieved by embracing the lessons learned in practice, found in the
literature and in the current media 4 and respecting the socio-technical complications
inherent in computerized healthcare.
8.3.6.1 Transitional Planning for Implementations
Having discussed at great length how health IT implementation can interrupt, modify,
break, or alter existing clinical processes, we must stress that these changes also
represent potential to improve care delivery processes. Prior to any implementation,
all providers must understand and cognitively “walk through” changes. They must
understand how and when they will generate or receive orders, whether the orders
will be on paper or electronically. A “cognitive walkthrough” 82, 83 that involves all
key personnel, including staff users, from the care delivery team is an extremely
powerful tool for uncovering implementation oversights and gaps in adapting to
proposed new care process. Such an exercise is helpful in identifying functional
problems at “handover” points (care transition) like nursing change of shift, physician
to physician sign-out rounds, and communications between nurses, social
work, aftercare planning staff and health unit coordinators.
Implementers, not physicians, must be aware of which orders are transmitted
electronically and which orders must be sent on paper. Often laboratory orders,