Evaluating Healthcare IT and Understanding the Work of Healthcare are Entangled Processes

Evaluating Healthcare IT and Understanding the Work of Healthcare are Entangled Processes

Joseph Schulman (New York Presbyterian Hospital, USA)
DOI: 10.4018/978-1-60566-030-1.ch002
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Abstract

Parallel to the monumental problem of replacing paper- and pen-based patient information management systems with electronic ones is the problem of evaluating the extent to which the change represents an improvement. Meaningful and useful evaluation rests upon: a) explicitly conceptualizing the goals and tasks of the daily clinical work; b) thinking of electronic information management technology as a cognitive tool; c) explicitly representing in the tool the pertinent information elements; d) selecting among possibilities for representing a problem formulation so as to facilitate the solution; and e) appreciating the dynamic interaction between the work and the tool–that changing a tool necessarily changes the work. Anchored in the story of how one hospital committee learned to think about the purpose and impact of a patient information management system, this chapter gives practical insight to these evaluative considerations.
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Which Elements Of The Daily Work Shall We Attend To?

One way to think about IT as a tool to facilitate the daily clinical work – which largely entails formulating and solving problems – is to decompose the work into its component processes:(Robertson, Elliot, & Washington, 2007)

  • 1.

    Seeking information

  • 2.

    Presenting information

  • 3.

    Organizing knowledge

Key Terms in this Chapter

Meta-Representation: The representation of the representational system – the explicit map of the portion of reality of interest. Reflection on the chosen map of reality actually tends to occur upon the meta-representation – the mental model of reality.

Problem Space: The collection of possible information configurations and actions that may transform them, in order to advance toward a goal; i.e. the circumstances within which the search for the solution to a problem can take place.

Representational System: A map of the reality over which it is hoped the associated cognitive tool will provide greater mastery. Such a system includes both that which is to be represented and that which does the representing – symbols.

Task: One of a set of actions – specific steps in a process – contributing to achieving a goal.

Task: One of a set of actions – specific steps in a process – contributing to achieving a goal.

Representational System: A map of the reality over which it is hoped the associated cognitive tool will provide greater mastery. Such a system includes both that which is to be represented and that which does the representing – symbols.

Meta-Representation: The representation of the representational system – the explicit map of the portion of reality of interest. Reflection on the chosen map of reality actually tends to occur upon the meta-representation – the mental model of reality.

Problem Solving: The process of moving from a starting point in the problem space to the goal.

Goal, Aim, Purpose: That which one seeks to achieve via a particular work operation; a desired result.

Patient Information Management System: A data management system that facilitates processing of patient information

Electronic Information Management Technology (IT): typically, a database software application (less sophisticated implementations occur in word-processing or spreadsheet software) running on some configuration of computer hardware

Electronic Information Management Technology (IT): typically, a database software application (less sophisticated implementations occur in word-processing or spreadsheet software) running on some configuration of computer hardware

Problem Solving: The process of moving from a starting point in the problem space to the goal.

Cognitive Tool: an artifact to represent and express what one knows; intended to aid human cognitive processing, to extend and facilitate what one could otherwise achieve unaided.

Problem Isomorph: A single problem can be stated in various ways, and often therefore can be variously represented. The particular representation, or problem isomorph, can influence the difficulty of solving the problem.

Problem Isomorph: A single problem can be stated in various ways, and often therefore can be variously represented. The particular representation, or problem isomorph, can influence the difficulty of solving the problem.

Cognitive Tool: an artifact to represent and express what one knows; intended to aid human cognitive processing, to extend and facilitate what one could otherwise achieve unaided.

Problem Space: The collection of possible information configurations and actions that may transform them, in order to advance toward a goal; i.e. the circumstances within which the search for the solution to a problem can take place.

IT Evaluation: The process of determining the degree to which an IT implementation facilitates the work of an individual or organization

Patient Information Management System: A data management system that facilitates processing of patient information

IT Evaluation: The process of determining the degree to which an IT implementation facilitates the work of an individual or organization

Goal, Aim, Purpose: That which one seeks to achieve via a particular work operation; a desired result.

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