Palmieri Patrick Albert, Peterson Lori T, Corazzo Luciano Bedoya
División de Negocios de Salud, Pacifico Peruano Suiza, Lima, Peru.
Adv Health Care Manag. 2011;10:287-312. doi: 10.1108/s1474-8231(2011)0000010023.
The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational-technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology-organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.
美国医学研究所（IOM）认为，健康信息技术（HIT）是提供安全、可靠且具成本效益的医疗服务必不可少的组织前提条件。然而，HIT是一把双刃剑，在生成改善系统性能的解决方案的同时，也催生了新的医源性问题。不一致的组织流程会导致技术医源性问题，即对系统完整性产生意外后果，以及由不一致的组织 - 技术接口加剧的组织结果。HIT对医疗服务组织来说是一种颠覆性创新，但仍是一个被忽视的组织发展（OD）问题。认识到因采用HIT而导致的技术与组织的失调，对于寻求消除系统不稳定根源的领导者来说很重要。健康信息技术医源性模型（HITIM）为领导者提供了一个概念框架，可据此将HIT视为组织发展的一种手段。创新的复杂性和扩散理论支持该框架，即每次采用HIT都起到技术变革推动者的作用。因此，领导者需要对通过实施HIT进行系统变革的管理人员进行运营监督。传统的风险管理工具，如失效模式影响分析和根本原因分析，可在实施前和实施后进行主动评估，以验证系统稳定性并提高系统可靠性。在新框架背景下重新考虑这些工具的使用，可为领导者在采用HIT以实现绩效提升和更好结果时提供指导。
