The long-term objective of this K99/R00 career development proposal is to improve the interaction between informatics tools and everyday clinical practice. A core premise of this proposal is that medication safety can be improved with informatics technologies that better support the safety-producing routines used by clinicians and patients. The PI is a medical and organizational anthropologist seeking to develop her capacity as an independent researcher through structured, innovative career development activities and two related research projects. Career development activities focus on human factors engineering and human centered design. The proposed projects each employ a cycle of work practice research, design, implementation and evaluation in two settings: hospital inpatient, and outpatient clinic. The work practice research methodology is Cultural Process Modeling, in which orienting frames (or mental models) and routine activities are identified through observation and interviewing and described for a specific group (e.g., a nursing unit). The data collection will focus on the use of informatics and other technologies in medication planning and administration. Special attention will be paid to transitions or handovers in care. A matrix will be used to describe the relationships between safe medication routines and attributes of technology that support or create barriers to safe practice. The PI will collaborate with clinical, management and informatics stakeholders to design and implement a work practice or informatics-based intervention to improve medication safety. Evaluation will focus on stakeholder experiences and value assessment using a Responsive/Illuminative approach. With projects that engage the complete cycle of 1) understanding context, 2) designing improved processes and tools, 3) implementation and 4) evaluation, this proposal views the implementation of informatics tools as organizational change. This research advances the emerging field of Implementation Science in informatics, which seeks to apply knowledge, theory and methods from social and organizational science, safety science, engineering and other fields to improve informatics implementation processes and outcomes. Implementation Science, applied to health informatics, can result in improved patient safety, efficiency, and technology adoption and user satisfaction.
This qualitative approach to understanding the interaction between informatics technology and clinical practice will 1) contribute important new knowledge about the mechanisms by which informatics tools support and/or impede safe medication practices, and 2) develop a research methodology for understanding technology implementation and use that can be adapted to a variety of clinical, institutional, domestic and virtual settings.
|Novak, Laurie Lovett; Holden, Richard J; Anders, Shilo H et al. (2013) Using a sociotechnical framework to understand adaptations in health IT implementation. Int J Med Inform 82:e331-44|