Aarts Jos, Van Der Sijs Heleen
Institute of Health Policy and Management, Erasmus MC, Rotterdam, The Netherlands.
Stud Health Technol Inform. 2009;148:165-9.
Ten years ago research of the impact of health information technology (HIT) on medical work practices started at Erasmus MC. The research is characterized by practice driven field research. From the beginning computerized physician order entry systems (CPOE) were a major topic. Research questions were how implementation of CPOE could be understood, how physicians were responding to reminders and alerts and how CPOE impacted professional workflow and collaboration. Studies of CPOE implementation aimed to understand why the adoption rate is so low and riddled with difficulties. Studies of reminders and alerts addressed the problem of alert fatigue. Finally, studies of workflow explored how CPOE influenced clinical workflow and how simplistic and linear models underlying CPOE may lead to poor designed systems and even compromise patient safety. Findings include the need for a shared understanding of medical challenges when implementing CPOE, conceptual models to understand alert fatigue and medical workflow and the impossibility of agreeing which alerts to suppress hospital-wide. The underlying research principle is the sociotechnical approach, which stipulates that technology, people and organizations should be studied from a single theoretical framework. This paper summarizes the results of ten years of research.
十年前，伊拉斯姆斯医学中心（Erasmus MC）开始了关于健康信息技术（HIT）对医疗工作实践影响的研究。该研究以实践驱动的实地研究为特点。从一开始，计算机化医师医嘱录入系统（CPOE）就是一个主要课题。研究问题包括如何理解CPOE的实施情况、医生对提醒和警报的反应如何，以及CPOE如何影响专业工作流程和协作。CPOE实施的研究旨在弄清楚为何采用率如此之低且充满困难。提醒和警报的研究解决了警报疲劳问题。最后，工作流程的研究探讨了CPOE如何影响临床工作流程，以及CPOE背后过于简单和线性的模型可能如何导致设计不佳的系统，甚至危及患者安全。研究结果包括在实施CPOE时需要对医疗挑战有共同的理解、用于理解警报疲劳和医疗工作流程的概念模型，以及在全院范围内就抑制哪些警报达成一致意见的不可能性。潜在的研究原则是社会技术方法，该方法规定应从单一理论框架对技术、人员和组织进行研究。本文总结了十年的研究成果。
