ABSTRACT
Information in Health Care ................................................................................. 98 Information and Errors .................................................................................... 98
Cognitive Work Design Methods and Health Care Information Systems .... 98 Information Trail Model for Cognitive Work Analysis and Design ............ 101
Modeling Elements ........................................................................................ 101 State Changes and Unit Operations ........................................................ 101 Information Piece ...................................................................................... 103 Information Trail ........................................................................................ 105
Information Trail Modeling Phases .................................................................. 105 Phase 2: Information Modeling .................................................................... 105
Step 1: Data Gathering: Information Piece Identification at Significant States ........................................................................................ 108 Step 2: Information Node Population..................................................... 109 Step 3: Information Abstraction and Strategy Discovery .................... 113 Transition from OR to ICU: Case Example of an Information Trail Model .......................................................................................................... 116
Phase 3: Meta-Analysis, Thematic Analysis, and Prioritization of Design Needs .................................................................................................. 120
Discussion ............................................................................................................ 120 Concurrency of Information in the System ................................................ 120 Repetition of Information .............................................................................. 121 Information Visualization ............................................................................. 121 Storage of Information ................................................................................... 121 Strategies in Information Transformation .................................................. 122 Markers and Signs .......................................................................................... 122
Conclusions .......................................................................................................... 122 Acknowledgment ................................................................................................ 123 References ............................................................................................................. 123
Information and Errors
Inadequate design support for information-based cognitive work continues to cause significant medical errors (Wilson et al. 1995; Kohn et al. 1999; Leape and Berwick 2005; Williams et al. 2007). Problems include availability of and timely access to information, lack of information integration, and poor provisions for sharing and transfer of accurate information (Ash et al. 2004; Brennan et al. 2004; Arora 2005; Calleja et al. 2011). For example, in a landmark study, Leape et al. (1995) found that not having enough information support precipitated 7 of 16 system failures and contributed to 78% of all adverse drug events observed in their study. Similarly, Wilson et al. (1999) found that poor sharing of essential information contributed to over 74% of preventable adverse events. Information discrepancies in medication orders, uncertainties in diagnosis from lack of information, and inadequate clinical decision support also cause medical errors (Barker et al. 2002; Croskerry 2003; Shulman et al. 2005; Koppel et al. 2008; Halbesleben et al. 2010). The potential for expensive medical errors heightens the need to examine how we design, operate, and maintain health care information systems.
