Journal:Undertaking sociotechnical evaluations of health information technologies

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Full article title Undertaking sociotechnical evaluations of health information technologies
Journal Informatics in Primary Care
Author(s) Cresswell, Kathrin M.; Sheikh, Aziz
Author affiliation(s) School of Health in Social Science, University of Edinburgh; Centre for Population Health Sciences, University of Edinburgh
Primary contact Email: kathrin.beyer@ed.ac.uk
Year published 2014
Volume and issue 21 (2)
Page(s) 78–83
DOI 10.14236/jhi.v21i2.54
ISSN 2058-4563
Distribution license Creative Commons Attribution 2.5 Generic
Website 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.[1] 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.[2]

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.[3][4][5][6][7][8][9]

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[3][4][5][6][7][8][9], 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[10][11][12][13][14][15][16], 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

  1. ↑ Coiera, E. (2009). "Building a National Health IT System from the middle out". Journal of the American Medical Informatics Association 16: 271–3. doi:10.1197/jamia.M3183. PMC PMC2732241. PMID 19407078. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732241. 
  2. ↑ Greenhalgh, T.; Stones, R. (2010). "Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory". Social Science and Medicine 70: 1285–94. doi:10.1016/j.socscimed.2009.12.034. PMID 20185218. 
  3. ↑ 3.0 3.1 Catwell, L.; Sheikh, A. (2009). "Evaluating eHealth interven-tions: the need for continuous systemic evaluation". PLoS Medicine 6: e1000126. doi:10.1371/journal.pmed.1000126. PMC PMC2719100. PMID 19688038. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719100. 
  4. ↑ 4.0 4.1 Berg, M.; Aarts, J.; van der Lei, J. (2003). "ICT in health care: socio-technical approaches". Methods of Information in Medicine 42: 297–301. PMID 14534625. 
  5. ↑ 5.0 5.1 Cresswell, K.; Worth, A.; Sheikh, A. (2010). "Actor-network theory and its role in understanding the implementation of information technology developments in healthcare". BMC Medical Informatics and Decision Making 10: 67. doi:10.1186/1472-6947-10-67. PMC PMC2988706. PMID 21040575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988706. 
  6. ↑ 6.0 6.1 "Health IT and Patient Safety: Building Safer Systems for Better Care" (PDF). Institute of Medicine. 2011. http://www.iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HIT%20and%20Patient%20Safety.pdf. Retrieved 16 July 2013. 
  7. ↑ 7.0 7.1 Cherns, A. (1987). "Principles of sociotechnical design revisited". Human Relations 40: 153–61. doi:10.1177/001872678704000303. 
  8. ↑ 8.0 8.1 Clegg, C.W. (2000). "Sociotechnical principles for system design". Applied Ergonomics 31: 463–77. doi:10.1016/S0003-6870(00)00009-0. 
  9. ↑ 9.0 9.1 Harrison, M.I.; Koppel, R.; Bar-Lev, S. (2007). "Unintended consequences of information technologies in health care—an interactive socio-technical analysis". Journal of the American Medical Informatics Association 14: 542–9. doi:10.1197/jamia.M2384. PMC PMC1975796. PMID 17600093. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1975796. 
  10. ↑ Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K.; Bokun, T.; et al. (2011). "The impact of eHealth on the quality and safety of health care: a systematic overview". PLoS Medicine 8: e1000387. 
  11. ↑ Sheikh, A.; Cornford, T.; Barber, N.; Avery, A.; Takian, A.; Lichtner, V.; et al. (2011). "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". British Medical Journal 343: d6054. doi:10.1136/bmj.d6054. PMC PMC3195310. PMID 22006942. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195310. 
  12. ↑ Robertson, A.; Cresswell, K.; Takian, A.; Petrakaki, D.; Crowe, S.; Cornford, T.; et al. (2010). "Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation". British Medical Journal 341: c4564. 
  13. ↑ Takian, A.; Petrakaki, D.; Cornford, T.; Sheikh, A.; Barber, N. (2012). "Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems". BMC Health Services Research 12: 105–29. doi:10.1186/1472-6963-12-105. PMC PMC3469374. PMID 22545646. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469374. 
  14. ↑ Westbrook, J.; Braithwaite, J.; Georgiou, A.; Ampt, A.; Creswick, A.; Coiera, E.; et al. (2007). "Multimethod evaluation of information and communication technologies in health in the context of wicked problems and sociotechnical theory". Journal of the American Medical Informatics Association 14: 746–55. doi:10.1197/jamia.M2462. PMC PMC2213479. PMID 17712083. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213479. 
  15. ↑ Greenhalgh, T.; Hinder, S.; Stramer, K.; Bratan, T.; Russell, J. (2010). "Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace". British Medical Journal 341: c5814. 
  16. ↑ Barber, N.; Cornford, T.; Klecun, E. (2007). "Qualitative evaluation of an electronic prescribing and administration system". Quality and Safety in Health Care 16: 271–8. doi:10.1136/qshc.2006.019505. PMC PMC2464937. PMID 17693675. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464937. 

Notes

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

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