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Chapter 26. Use of Clinical Simulations ... > UNDERSTANDING THE NEED FOR APPLYING ...

UNDERSTANDING THE NEED FOR APPLYING CLINICAL SIMULATIONS TO THE EVALUATION OF HEALTH INFORMATION SYSTEMS AND UBIQUITOUS COMPUTING DEVICES

The published research literature demonstrating the ability of HIS and UCD to improve patient and health care system processes and outcomes has been mixed. For example, Chaudry et al. (2006) in his systematic review of the health informatics literature found that HIS in conjunction with varying devices: (a) improved physician use of guidelines, (b) monitoring and surveillance of patient disease, and (c) decreased medication error rates (but only in healthcare organizations where home grown systems were being used). There were no proven improvements in the quality of patient care associated with the use of commercial HIS. As well, Chaudry and colleagues found that research on the cost-effectiveness of HIS/UCDs was limited and the findings that had been published in the literature were inconclusive. Eslami and colleagues in their 2007 and 2008 systematic reviews of the literature had similar findings. Eslami et al. (2007; 2008) found that implementing a computerized physician order system (i.e. the ordering of medications via computer) increased physician adherence to guidelines in outpatient settings, but that there was a lack of evidence to support the system's ability to improve patient safety and reduce the costs of providing patient care in outpatient care settings. Lastly, Ammenwerth et al. in her 2008 systematic review found that HIS/UCD may reduce the risk of medical errors when used by physicians, but at the same time acknowledged there is a need for more research in this area as the quality of the studies published to date are variable.

Other researchers found that some types of HIS and UCD may facilitate medical errors (e.g. Koppel et al. 2005). Koppel et al. (2005) found HIS system features and methods of implementing could facilitate medical errors in real-world settings if not de signed and implemented properly. Kushniruk et al. (2005) suggested the interaction between HIS and UCD (i.e. handheld devices) could potentially lead to technology-induced errors (e.g. where interface design features may induce users to unknowingly prescribe medications incorrectly and UCD features may influence decision making). Lastly, Schulman et. al. (2005) found that while some types of errors were reduced by HIS, new types of errors were also introduced or emerged with the introduction of the technology. This has lead some researchers (e.g. Borycki & Kushniruk, 2008; Koppel & Kreda, 2009) and healthcare organizations (e.g. The Joint Commission for Health Care Quality, 2008) to suggest there is a need to exercise caution and apply rigorous evaluation when implementing HIS and UCD in healthcare organizations. In response to these suggestions researchers have begun to call for the evaluation of differing constellations of HIS and UCD cognitive-socio-technical fit to prevent medical errors involving patients and health professionals from occurring (Borycki & Kushniruk, 2005; Borycki et al., 2009a). As Berg (1999), Kushniruk et al. (1992) and Koppel et al. (2005) suggest improving this fit may reduce the likelihood of unintended consequences.


  

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