The Importance of Contextual Understanding in Solving the Last Mile Problem

The COVID-19 pandemic has disrupted many global industries and shifted the digital health landscape by stimulating and accelerating the delivery of digital care. It has emphasized the need for a system level informatics implementation that supports the healthcare management of populations at a macro level while also providing the necessary support for front line care delivery at a micro level. From data dashboard to Telemedicine, this crisis has necessitated the need for health informatics transformation that can bridge time and space to provide timely care. However, heath transformation cannot solely rely on Health Information Technology (HIT) for progress, but rather success must be an outcome of system design focus on the contextual complexity of the health system where HIT is used. This conference highlights the important roles context plays for health informatics in global pandemics and aims to answer critical questions in four main areas: 1) health information management in the covid-19 context, 2) implementation of new practices and technologies in healthcare, 3) sociotechnical analysis of task performance and workload in healthcare, and 4) innovations in design and evaluation methods of health technologies. We deem this as a call to action to understand the importance of context while solving the last mile problem in delivering the informatics solutions that are needed to support our public health response.

An Interactive Sociotechnical Analysis of the Implementation of Electronic Decision Support in Antimicrobial Stewardship

Background: There is great enthusiasm for the potential of decision support tools embedded in the electronic medical record to improve antimicrobial use in hospitals. Yet they are often limited in their ability to change prescriber behavior. Analyzing these tools using an interactive sociotechnical approach (ISTA) can identify barriers and facilitators to the implementation of electronic decision support (EDS) in antimicrobial stewardship. Objective: To examine prescriber and antimicrobial steward perceptions of EDS using an ISTA approach in the preimplementation phase of an antimicrobial stewardship intervention. Methods: We conducted semistructured interviews with prescribers and stewards from 4 hospitals in 2 health systems in the context of a multicomponent intervention to improve the use of fluoroquinolones and extended-spectrum cephalosporins. Sites planned to implement various EDS elements including order sets, antimicrobial time outs, and audit with feedback stewardship notes in the medical record. Interviews elicited respondent perceptions about the planned intervention. Two analysts systematically coded transcripts using an ISTA framework in NVivo12 software. Results: Interviews with 64 respondents were conducted: 38 physicians, 7 nurses, 6 advanced practice providers, and 13 pharmacists. We identified 4 key sociotechnical interaction types likely to influence stewardship EDS implementation. First, EDS changes the communication patterns and practices of antimicrobial stewards in a way that improves efficiency but decreases vital social interaction with prescribers to facilitate behavior change. Second, there is a gap between what stewards envision for EDS and that which is possible to build in a timely manner by hospital information technology specialists. As a result, there is often a months- to years-long delay from proposal to implementation, which negatively affects intervention acceptance. Third, prescribers expressed great enthusiasm for stewardship EDS that would simplify their workload, allow them to complete important work tasks, and save time. They strongly objected to stewardship EDS that was disruptive without a compelling purpose or did not integrate smoothly with pre-existing technology infrastructure. Fourth, physician prescribers attributed social and emotional meaning to stewardship EDS, suggesting that these tools can undermine professional authority, autonomy, and confidence. Conclusions: Implementing stewardship EDS in a way that improves the use of antimicrobials while minimizing unintended negative consequences requires attention to the interplay between new EDS and an organization’s existing workflow, culture, social interactions and technologies. Implementing EDS in stewardship will require attention to these domains to realize the full potential of these tools and to avoid negative unintended consequences.Funding: NoneDisclosures: None

Humanization and Macroergonomics: An Analysis in the Billing Sector of a University Hospital in Paraná

The humanization of organizations is a trend in companies that have a vision of the future aligned with the needs of the market. In the health area, this humanization should not be limited to its users, but include the employees involved in the work system. The human aspect and its relations with the work system is a focus of studying ergonomics, which in its macroergomic approach aims at integrating organization-man-machine systems into a sociotechnical and participatory context. This study aims to apply the macroergonomic approach with health workers in order to propose and implement improvements; evidencing the importance of their involvement in better acceptance of the proposed improvements generating greater satisfaction. To this end, a study was conducted in the Billing sector of a Brazilian Hospital. Ergonomic demands were identified in a participatory way through the Macroergonomic Analysis of Work (MAW) method, proposed in [1]. The results were tabulated and divided into constructs: Environment, Biomechanical, Cognitive, Work Organization, Risk, Company and Discomfort/Pain. After one year, a new macroergonomic evaluation was carried out and the improvements implemented included the concept of the sociotechnical system, which were: i) acquisition of new computers; ii) implementation of a new computational system and; iii) implementation of changes in the form of sector management. The results showed an increase of up to 40% in satisfaction with the improvements implemented in the Biomechanical and Organizational constructs, indicating that the application of participatory ergonomics and macroergonomics was fundamental for the changes made to increase satisfaction in aspects of the work performed by them. Finally, this research highlights the importance of employee involvement in sociotechnical analysis for the humanization of organizations and it is suggested for future studies the proposition of improvements related to the Environment and Cognitive constructs and pain/discomforts.

Career challenges in smart cities: A sociotechnical systems view on sustainable careers

Smart cities are a modern reality in an increasingly digitized and fast changing world; and, as multidimensional, multilayered and interconnected career ecosystems they bring a number of challenges for the development of sustainable careers. What are the systemic roots of these challenges, and how can we deal with them to support the emergence of sustainable careers? We draw on a sociotechnical approach, supplemented by a dynamic person–environment fit perspective, to describe two systemic challenges tied to the development of sustainable careers in smart cities, namely: (1) an unbalanced fit, in that the highly digitized context fits best with highly educated and information and communications technology (ICT) literate citizens working in knowledge intensive organizations; and (2) a volatility of fit, associated with the complex and fast-changing smart urban context. Based on the sociotechnical analysis, we put forth three suggestions for addressing these challenges and creating a sustainable career ecosystem focused on: (1) the continuous development of ICT literacy, knowledge, talents and skills; (2) citizen participation and career communities; and (3) network-centric organizing of sustainable careers that could alleviate some of the challenges associated with the parallel development of sustainable careers and smart cities.