IT in Health Care

Patient care information systems (PCISs) can be extremely beneficial in a health care system. Some of the pros of PCISs include patient records becoming electronic, “eliminating illegible orders, improving communication, improving the tracking of orders, and reminding professionals of actions to be undertaken” (Ash, Berg, & Coiera, 2004, p. 104). On the other hand, PCISs can cause unintended errors and problems in a health care system that may affect workflow and patient care. The authors (Ash et al., 2004) identify two main categories of problems with the user interface of the PCIS: entering and retrieving information and communication and coordination (p. 106). While entering information, errors may occur due to choices being too close to one another on the screen; doctors may get distracted in conversation with a patient and mistakenly select the wrong choice. Even worse than choosing the incorrect response, an order may be placed for the wrong person. User interfaces may also require the user to enter information in a structured format which is much different than the normal “free text” format and the information then loses the “personal touch” of the user (Ash et al., 2004, p. 106).

Problems with communication and coordination include loss of communication and inflexibility and inability to detect urgency. “Physicians may assume that ‘entry’ into the computer system replaces their previous means of initiating and communicating their plans, and that orders will be carried out without further action on their part” (Ash et al., 2004, p. 109). The result is a loss in direct communication between doctors, nurses, and lab technicians and an increased reliance on the PCIS. The inflexibility of the system can be seen when an order is placed that makes sense on paper, but the information system tries to be “smart” and make a correction to the order. In a health care environment, a system must be dynamic and open to manual overrides. Urgency is also an important part of the health care atmosphere; a nurse may give medication to a patient without the doctor’s orders because it is necessary at that moment. The nurse then tries to enter the information, but the information system will not accept the entry because a doctor did not previously order it.

As problems can occur in the exchange of information between personnel in a health care system, they can also occur in transactions. “A transaction consists of an exchange of a product or service for money. Consequently, there is always a risk that something might go wrong in the exchange” (Post & Anderson, 2006, p. 209). Risks for the vendor include not receiving a payment, a fraudulent payment, or the government might invalidate the transaction (Post & Anderson, 2006, p. 209). The customer must be concerned about being charged the proper amount, receiving the product they purchased and whether the transaction is legal (Post & Anderson, 2006, p. 210).

In my mind, one solution to create an efficient and effective PCIS would be to create a nationwide (or even worldwide) standard. This way, each health care entity could contribute to the design by giving comments and using the software in trial runs. Health care organizations would be working together to design a final product that allows everyone to perform their jobs using PCIS with the least amount of negative impact. Is this single application solution too ambitious?

Ash, J. S., Berg, M., & Coiera, E. (Mar/Apr 2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104-112.

Post, G. V., & Anderson, D. L. (2006). Management Information Systems: Solving business problems with Information Technology. New York: McGraw-Hill/Irwin.