Sittig Dean F, Singh Hardeep
UT-Memorial Hermann Center for Healthcare Quality & Safety, University of Texas School of Biomedical Informatics at Houston, 6410 Fannin St UTPB 1100.43, Houston, TX 77030, USA.
Qual Saf Health Care. 2010 Oct;19 Suppl 3(Suppl 3):i68-74. doi: 10.1136/qshc.2010.042085.
Conceptual models have been developed to address challenges inherent in studying health information technology (HIT).
This manuscript introduces an eight-dimensional model specifically designed to address the sociotechnical challenges involved in design, development, implementation, use and evaluation of HIT within complex adaptive healthcare systems.
The eight dimensions are not independent, sequential or hierarchical, but rather are interdependent and inter-related concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the 'language' of clinical applications. The human--computer interface includes all aspects of the computer that users can see, touch or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end user, including potential patient-users. Workflow and communication are the processes or steps involved in ensuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organisational features (eg, policies, procedures and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.
已开发出概念模型以应对健康信息技术（HIT）研究中固有的挑战。
本文介绍了一个八维模型，该模型专门设计用于应对复杂适应性医疗系统中HIT的设计、开发、实施、使用和评估所涉及的社会技术挑战。
这八个维度并非相互独立、依次排列或分层的，而是相互依存且相互关联的概念，类似于其他复杂适应性系统的组成部分。硬件和软件计算基础设施指用于驱动、支持和操作临床应用及设备的设备和软件。临床内容指构成临床应用“语言”的文本或数字数据及图像。人机界面包括用户在与计算机交互时能看到、触摸或听到的计算机的所有方面。人员指以某种方式与系统交互的所有人，从开发者到最终用户，包括潜在的患者用户。工作流程和通信是确保有效执行患者护理任务所涉及的过程或步骤。该模型的另外两个维度是内部组织特征（如政策、程序和文化）以及外部规则和法规，这两者都可能促进或限制上述维度的许多方面。最后一个维度是测量和监测，它指测量和评估HIT实施和使用的预期和非预期后果的过程。我们举例说明了我们的模型如何在现实世界的复杂适应性环境中成功应用，以在开发和实施的各个阶段理解和改进HIT应用。
