Content area
Full Text
Introduction
An ongoing challenge to the design, development, implementation and evaluation of health information technology (HIT) interventions is to operationalise their use within the complex adaptive healthcare system that consists of high-pressured, fast-paced and distributed settings of care delivery. Many conceptual models of user interaction, acceptance and evaluation exist, 1 2 but most are relatively limited in scope. Given the dearth of models that are specifically designed to address safe and effective HIT development and use, we have developed a comprehensive, sociotechnical model that provides a multidimensional framework within which any HIT innovation, intervention, application or device implemented within a complex adaptive healthcare system can be studied. This model builds upon and bridges previous frameworks, and is further informed by our own work to study the safe and effective implementation and use of HIT interventions. In this paper, we describe the conceptual foundations of our model and provide several examples of its utility for studying HIT interventions within real-world clinical contexts.
Background
Previous analyses of HIT interventions have been limited by a lack of conceptual models that have been specifically developed for this purpose. Examples of models previously applied by HIT investigators include Rogers' diffusion of innovations theory, 3-5 Venkatesh's unified theory of acceptance and use of technology, 6-9 Hutchins' theory of distributed cognition, 10-14 Reason's Swiss Cheese Model 15-17 and Norman's seven-step human-computer interaction (HCI) model. 18-20 Although all of these models account for one or more important facets of technology implementation, we believe that the scope of each model limits its utility to address the full range of factors that should be considered in the design, development, implementation, use and evaluation of HIT interventions. For example, these models were not specifically designed to address the complex relationships between the HIT hardware, software, information content and HCI. Furthermore, while most of these models provide general guidance to study the high-level aspects of HIT implementation within a given clinical environment, none of them includes a measurement and monitoring infrastructure (eg, methods to routinely collect data, create or review reports or conduct surveillance of outcomes). Based on these limitations, our aim was to develop a more comprehensive model to integrate specific technological and measurement dimensions of HIT with other sociotechnical dimensions (eg, people, workflow, communication,...