Design of patient tracking tools probed.

Proper design of computational tools is critical if they are to be used with success in patient-care settings, particularly in hospital emergency rooms, according to a field study conducted by researchers at the University at Buffalo and other institutions.

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Nationwide, electronic patient tracking technologies are replacing traditional, dry-erase patient status boards, according to the UB researchers, who conducted the study with colleagues at the University of Rochester and the University of Florida, Jacksonville.

The researchers studied how new electronic patient-status boards were functioning in the emergency departments of two busy, university-affiliated hospitals.

Overall, they found that the computational tracking systems tended to affect how health care providers communicate information and track activities regarding patient care, which can cause providers to change the way they work.

The results provide an important case study of what can happen when new technologies are developed by designers who do not understand the nature of the work in which the technologies will be used, according to Ann Bisantz, Ph.D., a co-investigator on the study and associate professor of industrial and systems engineering in the UB School of Engineering and Applied Sciences.

"Research in human factors, the study of the interactions between humans and technology, has shown that in complex workplaces where safety is critical, such mismatches between the way practitioners work and the technologies that are supposed to support them can have unintended consequences, including inefficiencies and workarounds, where the technology demands that people change their work method," Bisantz said.

She noted that there were surface similarities between the manual patient-status whiteboards that emergency departments have traditionally used and the electronic ones that were installed. But in observations, focus groups and interviews with nurses, physicians, secretaries, IT specialists, and administrators showed UB researchers that the computerized systems were not designed to match all of the underlying functionality of the manual boards.

According to Bisantz, manual whiteboards perform a critical function for emergency departments, providing not just patient demographics, but also a means for health care workers to share information on patient complaints, vital signs, lab tests, consultations, dietary and allergy alerts, and notices about patient rooms that need to be cleaned.

The results, which were presented at the annual meeting of the Human Factors and Ergonomics Society, revealed that the innate flexibility of the manual whiteboard allowed health care providers and other emergency department staff to use it to communicate with one another.

"If you don't understand the underlying structure of the work that is being done in a particular setting, then you cannot design the technology that will best support it," Bisantz said.

Priyadarshini R. Pennathur, a doctoral candidate in the UB Department of Industrial and Systems Engineering, was a co-author on the research.