Skip to main content

Main menu

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Current Issue
  • Content
    • Current Issue
    • Early Access
    • Multimedia
    • Podcast
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • Plain Language Summaries
    • Calls for Papers
  • Info for
    • Authors
    • Reviewers
    • Job Seekers
    • Media
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • Podcast
    • E-mail Alerts
    • Journal Club
    • RSS
    • Annals Forum (Archive)
  • Contact
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
EditorialEditorial

On the Importance of Using a Multidimensional Sociotechnical Model to Study Health Information Technology

Dean F. Sittig and Joan S. Ash
The Annals of Family Medicine September 2011, 9 (5) 390-391; DOI: https://doi.org/10.1370/afm.1291
Dean F. Sittig
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: dean.f.sittig@uth.tmc.edu
Joan S. Ash
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • eLetters
  • Info & Metrics
  • PDF
Loading
  • Medical informatics
  • electronic prescribing
  • user-computer interfaces
  • computer systems evaluation

The Crosson et al1 and Koopman et al2 articles in this issue provide excellent illustrations and validation of the need for a systematic approach to make health information technology (HIT) safe and effective for use within health care. These studies can be viewed in this comprehensive context through the lens of a recently developed 8-dimension, sociotechnical model of HIT use.3,4 Briefly, this model offers a systems-level view and posits that all 8 of the interconnected dimensions of HIT must be adequately addressed if an organization is to achieve safe and effective electronic health record use. Failure to account for key items in any one of these dimensions can lead to almost insurmountable problems within the clinic.

The first aspect of this model, and the foundation of any e-prescribing or other HIT project, is represented by the hardware and software, which provide the features and functions the clinicians and office staff use to carry out the data entry, review, and transmission processes required to document their patient care activities. Crosson et al found in their observations that clinics required considerable on-site technical resources to help them implement and maintain the required technical infrastructure.

The clinical content required to implement the medication lists, drug dictionaries, formulary and billing information, and medication history, along with the drug-drug interaction checks, represents the second dimension of the model. The Koopman et al article provides an excellent overview of the detailed clinical knowledge (ie, content) that must be collected, managed, and effectively brought to bear at the right point in the clinical workflow to help clinicians solve complex patient care problems.5

The human-computer user interface, the third dimension, is critical. The article by Koopman et al describes an effective, highly specialized, condition-specific, human-computer interface developed to help clinicians in an ambulatory setting quickly and efficiently find all the information they need to provide high-quality diabetes care.

Certain special and essential personnel, represented by the fourth dimension, are required to design, develop or configure, implement, use, and evaluate all aspects of the HIT. The Koopman et al article highlights how clinically focused, human-computer interface evaluation experts can help clinicians evaluate new system functionality. The Crosson et al article illustrates the different skills and knowledge that are required to plan successfully (eg, clinical champions or opinion leaders), implement (eg, technical resources), and use (eg, superusers) such new HIT functions as e-prescribing. Often the incorporation of team members with complementary knowledge, skills, and experience can greatly improve the quality of the research and the implementation process and hence make the results or the system more useful.6

The fifth dimension of the model describes the communication and workflow processes into which any new or existing HIT functionality must fit.7 Crosson et al found that “successful adoption of e-prescribing required substantial investments of planning time and the ongoing transformation of work processes,” along with the development of new communication strategies, to successfully implement e-prescribing. Likewise, and most impressively, Koopman et al’s project developed a new user interface that reduced the mean number of mouse clicks required to complete the work task from 60 to 3!

Internal policies, procedures, and culture of the organization represent the critical sixth dimension. The article by Crosson et al provides a view of the many organizational policies, procedures, and perhaps most challenging, the cultural changes that a practice must make to implement an e-prescribing system successfully. One of the most difficult changes involves the participation in newly created health information exchanges and interactions with external pharmacies. Both of these external communication pathways are required by the US federal government’s new incentive programs.8 Such government programs include rules and regulations, the seventh dimension, which govern many of the system features, functions, and user actions. For example, the new user interface described by Koopman et al has the potential to reduce the cost and increase the quality and safety of the care provided. All of these benefits will be much more important should the currently dominant fee-for-service health care system be transformed into more of a pay-for-performance environment. Likewise, the study by Crosson et al highlights the difficult challenges facing ambulatory practices interested in participating in the government’s new meaningful use incentive plan.

The final dimension of the model covers all aspects of the measurement and monitoring required to identify problems, monitor system use and usability, and make the measurements required to evaluate the overall effect of the project. Both the Crosson et al and Koopman et al articles describe extensive system evaluations. The Crosson et al article reports on an external, multimethod, qualitative study of 5 ambulatory clinics using e-prescribing systems. The Koopman et al article describes use of a mobile usability laboratory to assess the utility of a new user interface. The methods described in these 2 articles will be of interest to others trying to gain insight through careful evaluation of the development or implementation of new HIT functionality.

The point is that no matter how good your new HIT system in general or your clinical decision support interventions in particular are, if you do not have adequate hardware to run the application, access to the data, a good place in the workflow to inject the system, people to take the actions recommended by the computer, and a regulatory environment that will allow the implementation to proceed, you will have difficulties. Proactive planning and evaluation through this 8-dimensional sociotechnical model of safe and effective HIT use can help organizations make sure that they have addressed all of the key requirements for any successful HIT project.

Footnotes

  • Conflicts of interest: authors report none.

  • Received for publication June 2, 2011.
  • Revision received June 2, 2011.
  • Accepted for publication June 6, 2011.
  • © Annals of Family Medicine, Inc.

References

  1. ↵
    1. Crosson JC,
    2. Etz RS,
    3. Wu S,
    4. Strauss SG,
    5. Eisenman D,
    6. Bell DS
    . Meaningful use of electronic prescribing in 5 exemplar primary care practices. Ann Fam Med. 2011;9(5):392–397.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Koopman RJ,
    2. Dochendorfer KM,
    3. Moore JL,
    4. et al
    . A diabetes dashboard and physician efficiency and accuracy in accessing data needed for high-quality diabetes care. Ann Fam Med. 2011;9(5)398–405.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Sittig DF,
    2. Singh H
    . Eight rights of safe electronic health record use. JAMA. 2009;302(10):1111–1113.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Sittig DF,
    2. Singh H
    . A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Qual Saf Health Care. 2010;19(Suppl 3):i68–i74.
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Sittig DF,
    2. Wright A,
    3. Simonaitis L,
    4. et al
    . The state of the art in clinical knowledge management: an inventory of tools and techniques. Int J Med Inform. 2010;79(1):44–57.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Ash JS,
    2. Stavri PZ,
    3. Dykstra R,
    4. Fournier L
    . Implementing computerized physician order entry: the importance of special people. Int J Med Inform. 2003;69(2–3):235–250.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Ammenwerth E,
    2. Iller C,
    3. Mahler C
    . IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Med Inform Decis Mak. 2006;6:3.
    OpenUrlCrossRefPubMed
  8. ↵
    1. Blumenthal D,
    2. Tavenner M
    . The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–504. Epub2010Jul13.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 9 (5)
The Annals of Family Medicine: 9 (5)
Vol. 9, Issue 5
September/October 2011
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
On the Importance of Using a Multidimensional Sociotechnical Model to Study Health Information Technology
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
On the Importance of Using a Multidimensional Sociotechnical Model to Study Health Information Technology
Dean F. Sittig, Joan S. Ash
The Annals of Family Medicine Sep 2011, 9 (5) 390-391; DOI: 10.1370/afm.1291

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
On the Importance of Using a Multidimensional Sociotechnical Model to Study Health Information Technology
Dean F. Sittig, Joan S. Ash
The Annals of Family Medicine Sep 2011, 9 (5) 390-391; DOI: 10.1370/afm.1291
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Practice Characteristics Associated with Better Implementation of Patient Self-Management Support
  • In This Issue: From Apprehension to Action
  • Google Scholar

More in this TOC Section

  • Information Technology in Primary Care Screenings: Ready for Prime Time?
  • All Quality Metrics are Wrong; Some Quality Metrics Could Become Useful
  • The AI Moonshot: What We Need and What We Do Not
Show more Editorial

Similar Articles

Content

  • Current Issue
  • Past Issues
  • Early Access
  • Plain-Language Summaries
  • Multimedia
  • Podcast
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Job Seekers
  • Media

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2025 Annals of Family Medicine