Question

-Summarize this paragraph?

1. Introduction It is acknowledged that introducing heath information technology (HIT) into clinical areas is complex, particularly when workflows are impacted (1). There is a wide body of research on unintended consequences that describe HIT implementation issues including communication issues, workflow issues, and contribution to or the creation of medical errors (2-5). Sometimes unintended consequences arise as a result of interventions to address other problems. For example, while HIT was advocated as a solution to prevent medical errors (6), it actually became the driver for a new category of errors called technology-induced errors (5). HIT issues are particularly problematic for front line clinical staff such as nurses. Despite our best attempts at automating a complex environment we still have trouble predicting how people and technology will interact, resulting in a variety of unintended consequences as described above. A complex adaptive system (CAS) is a system that displays properties such as emergent behaviors, non-linear processes, co- evolution, requisite variety, and simple rules [7]. As a system becomes more complex, the number of components and interactions between each component increase, both within the system itself, and between a system and its surrounding environment (8). Automating healthcare delivery through HIT is also a complex endeavor and could be informed by principles of complexity theory for understanding workflow and other aspects that are critical for HIT implementation (1) Articulating workflow complexities and how to evaluate and design HIT to manage the issues is particularly relevant to front line clinical staff such as nurses [9]. Corresponding author: Kuziemsky@telfer cottawa.ca CE Kazensky et al. / Studying the HIT-Complexity Interchange While it has been acknowledged that CASs can help us study, analyze and propose solutions for reconciling workflow and HIT implementation, an acknowledged shortcoming with using CASs for studying healthcare delivery is that it may simply be the new fad, or the emperors new clothes [8]. Much of the current research on CASS is descriptive in nature and lacks methodological rigor on how CASs should be used to understand HIT design and implementation [10] Evaluation approaches from usability engineering such as usability testing and cognitive task analysis have greatly enhanced our ability to understand how HIT needs to be tailored to fit the clinical context where it will be used (11-12). It has been suggested that multi-modal approaches to evaluation, for example combining think- aloud methodology with 'near-live clinical simulation can enhance evaluation by providing an environment that replicates real world clinical settings [12). While innovative usability approaches such as near-live evaluation have pushed the envelope of how we evaluate HIT, it works best if we can have an accurate model of the clinical environment. While the complexity of the clinical environment, and the impact it has on HIT implementation has been acknowledged, there are no studies that have combined clements of CASs and usability engineering to inform the design and evaluation of HIT. This paper addresses the above shortcoming and integrates the Cynefin model of CASs with approaches for HIT evaluation and systems analysis. The results are an integrated framework that can be used to classify and study user-task interactions with

Answer 1

Designing health information technology (HIT) to support care delivery is a complex sociotechnical endeavor that can result in defferent types of process interoperability issues . evaluating process interoperability takes time and longitudinal studies are necessery to understand the overall echo system where technology , processes , and people interact . the frame work developed in this paper provides a starting point for the evaluation of process interoperability and HIT .