Toward an Examination of the Social Conditions that Produce Clinical Information Technology

Abstract:

Medical errors have been the third leading cause of death in the US, responsible for over a quarter million deaths per year. The information systems that clinicians (such as physicians, nurses and pharmacists) use for work are often intended to reduce errors, but commonly have serious usability problems—creating new opportunities for error. While some of these usability problems may be due to simple oversight, many have origins in the complex sociotechnical conditions that shape and sustain clinical information systems. In this talk I examine usability issues in two information systems intended to improve patient safety: clinical decision support (CDS) and prescription drug monitoring programs (PDMPs). CDS systems commonly feature pop-up alerts to prevent dangerous prescriptions. PDMPs record patients’ opioid histories in statewide databases; these are commonly used to prevent recreational opioid use. In published work, I conducted a systematic review study, an interview and heuristic evaluation study, and a controlled simulation study to investigate ways to improve usability in these systems. CDS systems often create information overload, which can cause valuable guidance to be missed; I found that tailoring information to recipients’ clinical roles can increase prescriber acceptance. I also found that PDMPs lack key contextual information, creating an interpretive uncertainty that leads physicians to withhold beneficial pain medication. Lastly, I developed a novel, non-interruptive form of clinical decision support that presents graphical opioid history information as a prescriber composes a prescription. Resident physicians preferred my novel design, and attending physicians rated prescriptions made using my design as more appropriate. Yet, my design would not address the fundamental problems that PDMPs—as law enforcement databases—have. I outline a vision for future collaborative work in critical health informatics, combining technical expertise with social analysis to examine the sociotechnical conditions that underly systemic barriers to care and unjustified affronts to professional expertise that, in an increasingly technology-mediated healthcare system, often manifest as usability issues.

Bio:

Mustafa I. Hussain, MS is a PhD Candidate in Informatics at the University of California, Irvine. A computer scientist by training, he has used quantitative and qualitative methods to usability and social problems in clinical information technology. He has served as a University of California Irvine Pedagogical Fellow, as a member of the Student Editorial Board for the Journal of the American Medical Informatics Association, and as a union steward.