Understanding the work of pediatric inpatient medicine teams: implications for information system requirements

Health information systems tend to be designed primarily for data retrieval and data entry, with insufficient attention paid to the larger contexts in which work occurs. As a result, low physician acceptance and satisfaction remain barriers to the successful integration of current informational and decision support systems (e.g., CPOE systems). This paper reports on a qualitative field study of team-based clinical care work and decision making. Our aim is to consider a radical redesign of clinical information systems, one that is built with context and the constraints of work practice in mind. We apply Cognitive Work Analysis (CWA) methods to characterize the work at a large children's hospital, and analyze these results to consider new designs for clinical information systems. In this study, we report on themes, constraints, and ideas for design, showing how our CWA analyses lead to designs that are very different from current technology information systems.