Improving Distributed Health Information Technology Integration through Enriched Context in Sociotechnical System Components

Author

Jeritt Thayer, University of Texas Health Science Center at HoustonFollow

Graduation Date

Summer 2024

Degree Name

Doctor of Philosophy (PhD)

School Name

McWilliams School of Biomedical Informatics at UTHealth Houston

Advisory Committee

Amy Franklin, PhD

Abstract

The design and architecture of health information technology (HIT) are in the process of a transformative shift. Monolithic code bases, which are several systems intertwined into a single program, are being split into multiple distributed programs that communicate across information networks. Thus far, only sparse knowledge exists about the challenges of distributed HIT, and the interaction of these architectures with other factors of the sociotechnical system, such as clinical content, is not well understood. Existing sociotechnical models describe the components within a healthcare system and the connections between components, but the types of relationships between each component are underspecified. Within these gaps is the potential for system failures or delays, which could lead to patient harm. Several researchers have identified potential ways for integrated CDS to malfunction. However, distributed systems combinatorially increase the potential for harm and create new complexities not previously identified. To improve systems, researchers have tried to better understand how information provided by the system is used. A common method utilizes system audit logs, which track user behavior, but these methods often ignore other aspects of the sociotechnical system. This dissertation will explore distributed CDS systems by cataloging malfunctions and evaluating the impact of system architecture. It will also uncover the implications and risks of novel designs for clinical decision support by triangulating the use of information across components of the sociotechnical model and considering clinical content across the system. Finally, this project will comparatively evaluate two architectural models, using caching as an example, to demonstrate the impact that incorporating contextual factors can have on HIT integration.

Comments

Journal article included in this dissertation:

Jeritt G Thayer, Amy Franklin, Jeffrey M Miller, Robert W Grundmeier, Deevakar Rogith, Adam Wright, A scoping review of rule-based clinical decision support malfunctions, Journal of the American Medical Informatics Association, Volume 31, Issue 10, October 2024, Pages 2405–2413, https://doi.org/10.1093/jamia/ocae187

Recommended Citation

Thayer, Jeritt, "Improving Distributed Health Information Technology Integration through Enriched Context in Sociotechnical System Components" (2024). Dissertations & Theses (Open Access). 64.
https://digitalcommons.library.tmc.edu/uthshis_dissertations/64

Keywords

Distributed Health Information Technology, Clinical Decision Support (CDS), Health Information Exchange (HIE), FHIR (Fast Healthcare Interoperability Resources), EHR (Electronic Health Record)