Appendix: Summary of Best Papers Selected for the 2020 Edition of the IMIA Yearbook,
Section Human Factors and Organizational Issues
Wang J, Liang H, Kang H, Gong Y
Understanding health information technology induced medication safety events by two
conceptual frameworks
Appl Clin Inform 2019;10:158–67
This paper reveals a new perspective to Health Information Technology (HIT) induced
medication errors through the application of two conceptual frameworks: the information
value chain (Coiera, 2016) used in conjunction with the sociotechnical model for HIT-related
errors (Sittig & Singh, 2010) can enhance measurement and facilitate identification
of the most significant risks to patient safety.
Relying on the two conceptual frameworks and the National Coordinating Council for
Medication Errors Reporting and Prevention (NCC MERP) taxonomy, a retrospective analysis
of 9-year safety reports from the US FDA (Food and Drug Administration) MAUDE (Manufacturer
and User Facility Device Experience) database (45,624 MAUDE reports were extracted;
3,521 reports were identified as HIT-related reports) was conducted. A hundred and
fifty-two unique reports met the inclusion criteria.
Results show a variety of contributing factors to risks which are mostly associated
with clinical content followed by human–computer interface, and people. While Organizational
and system-related contributing factors are critical underlying factors, they were
not directly highlighted. Results also provide an overview of how likely certain effect
may be brought on one step and how it affects the other adjacent steps (e.g., receiving wrong information causes making a wrong decision with a probability of
0.62, and the wrong information may lead to a wrong (probability: 0.38) or delayed
(probability: 0.56) care process, with a high chance of resulting in patient harm
(probability: 0.94)).
The application of the two conceptual frameworks to the MAUDE database may be a general
approach to analyze any event reports in the context of HIT. It may enhance the understanding
of HIT-induced problems, along with their causes and the identification of the most
significant risks to patient safety. This may have implication on (i) how to formalize
risk-related reporting template for HIT, and (ii) the development of a knowledge base
supported by case-based reasoning.
Lee JY, van Karnebeek CDM, Wasserman WW
Development and user evaluation of a rare disease gene prioritization workflow based
on cognitive ergonomics
J Am Med Inform Assoc 2019;26(2):124–33
This paper is interested in understanding human cognitive capabilities and applying
this understanding to support human cognition via the design and evaluation of a human–system
interaction for optimized performance in gene prioritization activities. The authors
designed a novel workflow in which clinicians recalled known genetic diseases with
similarity to patient phenotypes to inform data interpretation. This prototype-based
workflow was evaluated against the common computational approach based on physician-specified
sets of individual patient phenotypes. An evaluation was conducted as a web-based
user study, in which 18 clinicians analyzed two simulated patient scenarios using
a randomly assigned workflow. Data analysis compared the two workflows with respect
to accuracy and efficiency in diagnostic interpretation, efficacy in collecting detailed
phenotypic information, and user satisfaction.
Results demonstrated that gene interpretation could be accelerated using the prototype-based
workflow by facilitating prototypical thinking. It was likely that participants employed
some level of prototypical thinking in both workflows, while the reasoning process
was more efficiently facilitated by the prototype-based workflow.
Patterson ES, Su G, Sarkar U
Reducing delays to diagnosis in ambulatory care settings: A macrocognition perspective
Appl Ergon 2020 Jan;82:102965
In this paper, the authors want to characterize contributors to diagnostic delays
by physicians that can be mitigated by work system redesign. To do so, they overlay
concepts from the theoretical framework of macrocognition upon a foundation of human
factors concepts, including a perspective on how to advance patient safety known as
Safety-II. In the outpatient care setting, complex tasks, conducted by a primary care
provider, are provided for five macrocognition functions: sensemaking, re-planning,
detecting problems, deciding, and coordinating. Relying on an interdisciplinary team,
the authors held a series of meetings to redesign systems in order to reduce delays
to diagnosis by helping users to avoid missed symptoms, forgotten follow-up activities,
and delayed actions.
For each critical task, relying on the five macrocognition functions, the authors
identified vulnerabilities in care provision in the outpatient setting that can contribute
to diagnostic delays. Resilience strategies were proposed that can mitigate these
vulnerabilities with work system redesign. The primary contribution of this paper
is a set of resilience strategies that could be supported by innovations in health
information technology (HIT) in future research.
Results augment an existing theoretical framework providing examples of how HIT could
be redesigned to make complex tasks easier. This effort represents a preliminary step
in a line of potentially useful research for reducing patient harm by providing ideas
for interventions that go beyond training or education. The paper is a nice contribution
of constructing a bridge between how human factors engineers conceptualize cognitive
work in a way that can suggest innovative design solutions.
