Journal:Undertaking sociotechnical evaluations of health information technologies - Revision history

Shawndouglas: Text replacement - "electronic health records" to "electronic health records"

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	==Introduction==		==Introduction==
	Internationally, there is a growing political drive to implement ever more complex information technologies into healthcare settings, in the hope that these will help improve the quality, safety, and efficiency of healthcare.<ref name="CoieraBuild09">{{cite journal \|title=Building a National Health IT System from the middle out \|journal=Journal of the American Medical Informatics Association \|author=Coiera, E. \|volume=16 \|pages=271–3 \|year=2009 \|doi=10.1197/jamia.M3183 \|pmid=19407078 \|pmc=PMC2732241}}</ref> There is in parallel a growing appreciation that such interventions need to be formally evaluated, as the benefits of technologies should not simply be assumed. Complex systems such as [[electronic health records]], and electronic prescribing and telemonitoring technologies are often very costly to procure and maintain, and so, even if effectiveness in relation to the quality of care is established, cost effectiveness needs to be examined. There is now also a growing body of work indicating that technologies may inadvertently introduce new risks, largely arising from difficulties of systems to integrate with existing work processes.<ref name="GreenhalghTheo10">{{cite journal \|title=Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory \|journal=Social Science and Medicine \|author=Greenhalgh, T.; Stones, R. \|volume=70 \|pages=1285–94 \|year=2010 \|doi=10.1016/j.socscimed.2009.12.034 \|pmid=20185218}}</ref>		Internationally, there is a growing political drive to implement ever more complex information technologies into healthcare settings, in the hope that these will help improve the quality, safety, and efficiency of healthcare.<ref name="CoieraBuild09">{{cite journal \|title=Building a National Health IT System from the middle out \|journal=Journal of the American Medical Informatics Association \|author=Coiera, E. \|volume=16 \|pages=271–3 \|year=2009 \|doi=10.1197/jamia.M3183 \|pmid=19407078 \|pmc=PMC2732241}}</ref> There is in parallel a growing appreciation that such interventions need to be formally evaluated, as the benefits of technologies should not simply be assumed. Complex systems such as [[Electronic health record\|electronic health records]], and electronic prescribing and telemonitoring technologies are often very costly to procure and maintain, and so, even if effectiveness in relation to the quality of care is established, cost effectiveness needs to be examined. There is now also a growing body of work indicating that technologies may inadvertently introduce new risks, largely arising from difficulties of systems to integrate with existing work processes.<ref name="GreenhalghTheo10">{{cite journal \|title=Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory \|journal=Social Science and Medicine \|author=Greenhalgh, T.; Stones, R. \|volume=70 \|pages=1285–94 \|year=2010 \|doi=10.1016/j.socscimed.2009.12.034 \|pmid=20185218}}</ref>

	The study of technological innovation into healthcare settings should therefore — particularly if the technology is likely to be disruptive — offer an opportunity to understand and evaluate the changing inter-relationships between technology and human/organisational (or socio-) factors. Whilst there is a growing theoretical and empirical evidence base on this subject, there is as yet little practical guidance explaining how such sociotechnical evaluations should be undertaken.<ref name="CatwellEval09">{{cite journal \|title=Evaluating eHealth interven-tions: the need for continuous systemic evaluation \|journal=PLoS Medicine \|author=Catwell, L.; Sheikh, A. \|volume=6 \|pages=e1000126 \|year=2009 \|doi=10.1371/journal.pmed.1000126 \|pmid=19688038 \|pmc=PMC2719100}}</ref><ref name="BergICT03">{{cite journal \|title=ICT in health care: socio-technical approaches \|journal=Methods of Information in Medicine \|author=Berg, M.; Aarts, J.; van der Lei, J. \|volume=42 \|pages=297–301 \|year=2003 \|pmid=14534625}}</ref><ref name="CresswellActor10">{{cite journal \|title=Actor-network theory and its role in understanding the implementation of information technology developments in healthcare \|journal=BMC Medical Informatics and Decision Making \|author=Cresswell, K.; Worth, A.; Sheikh, A. \|volume=10 \|pages=67 \|year=2010 \|doi=10.1186/1472-6947-10-67 \|pmid=21040575 \|pmc=PMC2988706}}</ref><ref name="IoMHealth11">{{cite web \|url=http://www.iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HIT%20and%20Patient%20Safety.pdf \|format=PDF \|title=Health IT and Patient Safety: Building Safer Systems for Better Care \|publisher=Institute of Medicine \|year=2011 \|accessdate=16 July 2013}}</ref><ref name="ChernsPrinc87">{{cite journal \|title=Principles of sociotechnical design revisited \|journal=Human Relations \|author=Cherns, A. \|volume=40 \|pages=153–61 \|year=1987 \|doi=10.1177/001872678704000303}}</ref><ref name="Clegg">{{cite journal \|title=Sociotechnical principles for system design \|journal=Applied Ergonomics \|author=Clegg, C.W. \|volume=31 \|pages=463–77 \|year=2000 \|doi=10.1016/S0003-6870(00)00009-0}}</ref><ref name="HarrisonUn07">{{cite journal \|title=Unintended consequences of information technologies in health care—an interactive socio-technical analysis \|journal=Journal of the American Medical Informatics Association \|author=Harrison, M.I.; Koppel, R.; Bar-Lev, S. \|volume=14 \|pages=542–9 \|year=2007 \|doi=10.1197/jamia.M2384 \|pmid=17600093 \|pmc=PMC1975796}}</ref>		The study of technological innovation into healthcare settings should therefore — particularly if the technology is likely to be disruptive — offer an opportunity to understand and evaluate the changing inter-relationships between technology and human/organisational (or socio-) factors. Whilst there is a growing theoretical and empirical evidence base on this subject, there is as yet little practical guidance explaining how such sociotechnical evaluations should be undertaken.<ref name="CatwellEval09">{{cite journal \|title=Evaluating eHealth interven-tions: the need for continuous systemic evaluation \|journal=PLoS Medicine \|author=Catwell, L.; Sheikh, A. \|volume=6 \|pages=e1000126 \|year=2009 \|doi=10.1371/journal.pmed.1000126 \|pmid=19688038 \|pmc=PMC2719100}}</ref><ref name="BergICT03">{{cite journal \|title=ICT in health care: socio-technical approaches \|journal=Methods of Information in Medicine \|author=Berg, M.; Aarts, J.; van der Lei, J. \|volume=42 \|pages=297–301 \|year=2003 \|pmid=14534625}}</ref><ref name="CresswellActor10">{{cite journal \|title=Actor-network theory and its role in understanding the implementation of information technology developments in healthcare \|journal=BMC Medical Informatics and Decision Making \|author=Cresswell, K.; Worth, A.; Sheikh, A. \|volume=10 \|pages=67 \|year=2010 \|doi=10.1186/1472-6947-10-67 \|pmid=21040575 \|pmc=PMC2988706}}</ref><ref name="IoMHealth11">{{cite web \|url=http://www.iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HIT%20and%20Patient%20Safety.pdf \|format=PDF \|title=Health IT and Patient Safety: Building Safer Systems for Better Care \|publisher=Institute of Medicine \|year=2011 \|accessdate=16 July 2013}}</ref><ref name="ChernsPrinc87">{{cite journal \|title=Principles of sociotechnical design revisited \|journal=Human Relations \|author=Cherns, A. \|volume=40 \|pages=153–61 \|year=1987 \|doi=10.1177/001872678704000303}}</ref><ref name="Clegg">{{cite journal \|title=Sociotechnical principles for system design \|journal=Applied Ergonomics \|author=Clegg, C.W. \|volume=31 \|pages=463–77 \|year=2000 \|doi=10.1016/S0003-6870(00)00009-0}}</ref><ref name="HarrisonUn07">{{cite journal \|title=Unintended consequences of information technologies in health care—an interactive socio-technical analysis \|journal=Journal of the American Medical Informatics Association \|author=Harrison, M.I.; Koppel, R.; Bar-Lev, S. \|volume=14 \|pages=542–9 \|year=2007 \|doi=10.1197/jamia.M2384 \|pmid=17600093 \|pmc=PMC1975796}}</ref>

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	\|caption =		\|caption =
	\|title_full = Undertaking sociotechnical evaluations of health information technologies		\|title_full = Undertaking sociotechnical evaluations of health information technologies
	\|journal = Informatics in Primary Care		\|journal = ''Informatics in Primary Care''
	\|authors = Cresswell, Kathrin M.; Sheikh, Aziz		\|authors = Cresswell, Kathrin M.; Sheikh, Aziz
	\|affiliations = School of Health in Social Science, University of Edinburgh; Centre for Population Health Sciences, University of Edinburgh		\|affiliations = School of Health in Social Science, University of Edinburgh; Centre for Population Health Sciences, University of Edinburgh

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	\|license = [http://creativecommons.org/licenses/by/2.5/ Creative Commons Attribution 2.5 Generic]		\|license = [http://creativecommons.org/licenses/by/2.5/ Creative Commons Attribution 2.5 Generic]
	\|website = [http://hijournal.bcs.org/index.php/jhi/article/view/54/80 http://hijournal.bcs.org/index.php/jhi/article/view/54/80]		\|website = [http://hijournal.bcs.org/index.php/jhi/article/view/54/80 http://hijournal.bcs.org/index.php/jhi/article/view/54/80]
			\|download = [http://hijournal.bcs.org/index.php/jhi/article/download/54/79 http://hijournal.bcs.org/index.php/jhi/article/download/54/79] (PDF)
	}}		}}

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{{Infobox journal article
|name =
|image =
|alt = 
|caption =
|title_full = Undertaking sociotechnical evaluations of health information technologies
|journal = Informatics in Primary Care
|authors = Cresswell, Kathrin M.; Sheikh, Aziz
|affiliations = School of Health in Social Science, University of Edinburgh; Centre for Population Health Sciences, University of Edinburgh
|contact = Email: kathrin.beyer@ed.ac.uk
|editors =
|pub_year = 2014
|vol_iss = '''21''' (2)
|pages = 78–83
|doi = [http://dx.doi.org/10.14236/jhi.v21i2.54 10.14236/jhi.v21i2.54]
|issn = 2058-4563
|license = [http://creativecommons.org/licenses/by/2.5/ Creative Commons Attribution 2.5 Generic]
|website = [http://hijournal.bcs.org/index.php/jhi/article/view/54/80 http://hijournal.bcs.org/index.php/jhi/article/view/54/80]
}}

==Abstract==
There is an increasing international recognition that the evaluation of health information technologies should involve assessments of both the technology and the social/organisational contexts into which it is deployed. There is, however, a lack of agreement on definitions, published guidance on how such ‘sociotechnical evaluations’ should be undertaken, and how they distinguish themselves from other approaches. We explain what sociotechnical evaluations are, consider the contexts in which these are most usefully undertaken, explain what they entail, reflect on the potential pitfalls associated with such research, and suggest possible ways to avoid these.

'''Keywords''': Evaluation, health information technology, sociotechnical

==Introduction==
Internationally, there is a growing political drive to implement ever more complex information technologies into healthcare settings, in the hope that these will help improve the quality, safety, and efficiency of healthcare.<ref name="CoieraBuild09">{{cite journal |title=Building a National Health IT System from the middle out |journal=Journal of the American Medical Informatics Association |author=Coiera, E. |volume=16 |pages=271–3 |year=2009 |doi=10.1197/jamia.M3183 |pmid=19407078 |pmc=PMC2732241}}</ref> There is in parallel a growing appreciation that such interventions need to be formally evaluated, as the benefits of technologies should not simply be assumed. Complex systems such as [[electronic health records]], and electronic prescribing and telemonitoring technologies are often very costly to procure and maintain, and so, even if effectiveness in relation to the quality of care is established, cost effectiveness needs to be examined. There is now also a growing body of work indicating that technologies may inadvertently introduce new risks, largely arising from difficulties of systems to integrate with existing work processes.<ref name="GreenhalghTheo10">{{cite journal |title=Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory |journal=Social Science and Medicine |author=Greenhalgh, T.; Stones, R. |volume=70 |pages=1285–94 |year=2010 |doi=10.1016/j.socscimed.2009.12.034 |pmid=20185218}}</ref>

The study of technological innovation into healthcare settings should therefore — particularly if the technology is likely to be disruptive — offer an opportunity to understand and evaluate the changing inter-relationships between technology and human/organisational (or socio-) factors. Whilst there is a growing theoretical and empirical evidence base on this subject, there is as yet little practical guidance explaining how such sociotechnical evaluations should be undertaken.<ref name="CatwellEval09">{{cite journal |title=Evaluating eHealth interven-tions: the need for continuous systemic evaluation |journal=PLoS Medicine |author=Catwell, L.; Sheikh, A. |volume=6 |pages=e1000126 |year=2009 |doi=10.1371/journal.pmed.1000126 |pmid=19688038 |pmc=PMC2719100}}</ref><ref name="BergICT03">{{cite journal |title=ICT in health care: socio-technical approaches |journal=Methods of Information in Medicine |author=Berg, M.; Aarts, J.; van der Lei, J. |volume=42 |pages=297–301 |year=2003 |pmid=14534625}}</ref><ref name="CresswellActor10">{{cite journal |title=Actor-network theory and its role in understanding the implementation of information technology developments in healthcare |journal=BMC Medical Informatics and Decision Making |author=Cresswell, K.; Worth, A.; Sheikh, A. |volume=10 |pages=67 |year=2010 |doi=10.1186/1472-6947-10-67 |pmid=21040575 |pmc=PMC2988706}}</ref><ref name="IoMHealth11">{{cite web |url=http://www.iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HIT%20and%20Patient%20Safety.pdf |format=PDF |title=Health IT and Patient Safety: Building Safer Systems for Better Care |publisher=Institute of Medicine |year=2011 |accessdate=16 July 2013}}</ref><ref name="ChernsPrinc87">{{cite journal |title=Principles of sociotechnical design revisited |journal=Human Relations |author=Cherns, A. |volume=40 |pages=153–61 |year=1987 |doi=10.1177/001872678704000303}}</ref><ref name="Clegg">{{cite journal |title=Sociotechnical principles for system design |journal=Applied Ergonomics |author=Clegg, C.W. |volume=31 |pages=463–77 |year=2000 |doi=10.1016/S0003-6870(00)00009-0}}</ref><ref name="HarrisonUn07">{{cite journal |title=Unintended consequences of information technologies in health care—an interactive socio-technical analysis |journal=Journal of the American Medical Informatics Association |author=Harrison, M.I.; Koppel, R.; Bar-Lev, S. |volume=14 |pages=542–9 |year=2007 |doi=10.1197/jamia.M2384 |pmid=17600093 |pmc=PMC1975796}}</ref>

Although there is an increasing appreciation of the complex processes involved in using and implementing technology in social contexts to improve the safety and quality of healthcare<ref name="CatwellEval09" /><ref name="BergICT03" /><ref name="CresswellActor10" /><ref name="IoMHealth11" /><ref name="ChernsPrinc87" /><ref name="Clegg" /><ref name="HarrisonUn07" />, current sociotechnical approaches somewhat fail to distinguish themselves from other methodologies such as usability testing and context-sensitive methods of investigation. This may be due to the lack of agreed existing definitions of what constitutes sociotechnical approaches to evaluation and the range of disciplinary backgrounds involved.

Drawing on our experience of conducting a number of recent studies of complex health information technologies<ref name="BlackThe09">{{cite journal |title=The impact of eHealth on the quality and safety of health care: a systematic overview |journal=PLoS Medicine |author=Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K.; Bokun, T.; et al. |volume=8 |pages=e1000387 |year=2011}}</ref><ref name="SheikhImp11">{{cite journal |title=Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from a prospective national evaluation in “early adopter” hospitals |journal=British Medical Journal |author=Sheikh, A.; Cornford, T.; Barber, N.; Avery, A.; Takian, A.; Lichtner, V.; et al. |volume=343 |pages=d6054 |year=2011 |doi=10.1136/bmj.d6054 |pmid=22006942 |pmc=PMC3195310}}</ref><ref name="RobertsonImp10">{{cite journal |title=Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation |journal=British Medical Journal |author=Robertson, A.; Cresswell, K.; Takian, A.; Petrakaki, D.; Crowe, S.; Cornford, T.; et al. |volume=341 |pages=c4564 |year=2010}}</ref><ref name="TakianBuild12">{{cite journal |title=Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems |journal=BMC Health Services Research |author=Takian, A.; Petrakaki, D.; Cornford, T.; Sheikh, A.; Barber, N. |volume=12 |pages=105–29 |year=2012 |doi=10.1186/1472-6963-12-105 |pmid=22545646 |pmc=PMC3469374}}</ref><ref name="WestbrookMulti07">{{cite journal |title=Multimethod evaluation of information and communication technologies in health in the context of wicked problems and sociotechnical theory |journal=Journal of the American Medical Informatics Association |author=Westbrook, J.; Braithwaite, J.; Georgiou, A.; Ampt, A.; Creswick, A.; Coiera, E.; et al. |volume=14 |pages=746–55 |year=2007 |doi=10.1197/jamia.M2462 |pmid=17712083 |pmc=PMC2213479}}</ref><ref name="GreenhalghAdop10">{{cite journal |title=Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace |journal=British Medical Journal |author=Greenhalgh, T.; Hinder, S.; Stramer, K.; Bratan, T.; Russell, J. |volume=341 |pages=c5814 |year=2010}}</ref><ref name="Barberqual07">{{cite journal |title=Qualitative evaluation of an electronic prescribing and administration system |journal=Quality and Safety in Health Care |author=Barber, N.; Cornford, T.; Klecun, E. |volume=16 |pages=271–8 |year=2007 |doi=10.1136/qshc.2006.019505 |pmid=17693675 |pmc=PMC2464937}}</ref>, we aim to provide a practical guide to undertaking sociotechnical evaluations: we consider the contexts in which such approaches are most usefully employed, explain what sociotechnical evaluations involve, and reflect on the potential pitfalls associated with such work and how these might be avoided.

==References==
<references />

==Notes==
This presentation is faithful to the original, with only a few minor changes to presentation.


[[Category:LIMSwiki journal articles (all)‎]]
[[Category:LIMSwiki journal articles on health informatics‎‎]]