Thinking Together: Modeling Clinical Decision-Support as a Sociotechnical System

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Sociology of Technology

Background:

• Computerized clinical decision-support systems (CDS) are complex sociotechnical systems involving human and automated actors.
• Sociotechnical considerations are often overlooked in CDS literature, hindering comparative evaluation and practical implementation.
• Existing research lacks a framework to systematically analyze the sociotechnical aspects of CDS.

Purpose of the Study:

• To develop a flexible model for representing CDS as sociotechnical systems.
• To facilitate the comparative evaluation of CDS implementations in research.
• To improve sociotechnical planning and communication in the practice of CDS.

Main Methods:

• Literature review focusing on Distributed Cognition (DCog) theory.
• Development of the 'Thinking Together' model, a diagrammatical tool for sociotechnical analysis.
• Application of the model to two diverse case studies of CDS (highly automated vs. minimally automated).

Main Results:

• The Thinking Together model effectively represents CDS as sociotechnical systems.
• The model's flexibility was demonstrated across case studies with varying levels of automation.
• The model supports comparative evaluation in research and planning in practice.

Conclusions:

• The Thinking Together model, informed by DCog, provides a valuable framework for sociotechnical analysis of CDS.
• Explicit consideration of sociotechnical context is crucial for successful CDS implementation.
• The model enhances both research-based evaluation and practical application of CDS.