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

Chapter 8
Complexity in Healthcare Information
Technology Systems
Willa H. Drummond, Jeffrey M. Ferranti, Christoph U. Lehmann
and Donald E. Lighter
Objectives
The reader will be able to:
Understand that the implementation of a healthcare computer/human system is a
complexly interacting change agent that will alter the status quo
Organize a logical approach to evaluating human/computer/healthcare interaction
problems in pediatric environments
Participate effectively in local, cross-disciplinary, team-based process improvement
efforts
8.1 Introduction
Changes in healthcare processes are implemented with the goal to improve care
through improved patient safety, reduction in costs and work load, and improved
communication. However, change often triggers unintended consequences that may
cause stress to other healthcare system components, sometimes to a point of outright
failure. Change that improves a process in one hospital will not necessarily succeed
in another. This chapter discusses how health information techno logy (HIT) as a
change agent affects health care delivery in predictable as well as unpredictable ways.
We will explore the complexity of existing health care structures using evaluative
scenarios of IT implementations. HIT implementations add complexity that may
break existing workflow processes and interrupt care delivery in unexpected ways.
8.1.1 Health IT as Change Agent
The implementation of IT systems in health care changes the delivery of clinical
care in ways that can have unexpected negative consequences. 1–3 An IT system may
destabilize the workflow of a clinical site such as a physician’s office, hospital, or
inpatient unit (i.e. ICU) with cascading downstream effects on associated processes.
C.U. Lehmann et al. (eds.), Pediatric Informatics: Computer Applications 83
in Child Health, Health Informatics,
© Springer Science + Business Media, LLC 2009