A review of medical error reporting system design considerations and a proposed cross-level systems research framework

OBJECTIVE: To review the literature on medical error reporting systems, identify gaps in the literature, and present an integrative cross-level systems model of reporting to address the gaps and to serve as a framework for understanding and guiding reporting system design and research. BACKGROUND: Medical errors are thought to be a leading cause of death among adults in the United States. However, no review exists summarizing what is known about the barriers and facilitators for successful reporting systems, and no integrated model exists to guide further research into and development of medical error reporting systems. METHOD: Relevant literature was identified using online databases; references in relevant articles were searched for additional relevant articles. RESULTS: The literature review identified components of medical error reporting systems, error reporting system design choices, barriers and incentives for reporting, and suggestions for successful reporting system design. Little theory was found to guide the published research. An integrative cross-level model of medical error reporting system design was developed and is proposed as a framework for understanding the medical error reporting literature, addressing existing limitations, and guiding future design and research. CONCLUSION: The medical error reporting research provides some guidance for designing and implementing successful reporting systems. The proposed cross-level systems model provides a way to understand this existing research. However, additional research is needed on reporting and related safety actions. The proposed model provides a framework for such future research. APPLICATION: This work can be used to guide the design, implementation, and study of medical error reporting systems.     

Multiple user considerations and their implications in medical error reporting system design

OBJECTIVE: The study examined the differences between physicians and clinical assistants in their preferences for a statewide medical error reporting system. BACKGROUND: Medical error reporting systems have been proposed as a means for studying the causes of medical error. Knowledge of user similarities and differences is needed for the development of design guidelines for medical error reporting systems. METHOD: Separate focus groups composed of 8 physicians and 6 clinical assistants (physician clinical support staff) were conducted. One-hour focus group meetings were conducted via toll-free teleconference lines one to two times per month for 9 months. All conversations were audiotaped and transcribed for analysis. An inductive content analysis was conducted. RESULTS: Eighty-six major and minor themes emerged. Differences between physicians and clinical assistants included rules and regulations governing the use of the system, the medium of reporting, and aspects of the organization that may affect reporting levels. CONCLUSIONS: Although physicians and clinical assistants shared similar preferences and beliefs surrounding error reporting, there were differences that need to be considered if medical error reporting systems are to be effective. APPLICATION: To successfully deploy a medical error reporting system, the system itself must be designed for the potential users. This study uncovered previously underappreciated issues that should be incorporated into the design and implementation process. Actual or potential applications of this research include the improvement of the design and implementation of medical error reporting systems to account for the needs of different types of users.     

Integrating switching costs to information systems adoption: An empirical study on learning management systems

When evaluating a new information system, users’ experiences with the prior system, as well as characteristics of the new system, may influence their adoption behavior. However, most existing research either focuses solely on assessment of the new system using information systems adoption theories, or focuses only on the extent and types of switching costs associated with the transition from the prior system to the new one. In addition, little research has examined system switching and adoption of new learning management systems. To address these gaps, this study develops a research model that integrates the theoretical perspectives of switching costs and information systems adoption. The model is developed and tested in the context of the adoption of learning management systems. The results indicate that emotional costs and reduced performance costs can significantly influence perceived switching value. Perceived switching value, performance expectancy, effort expectancy, and social influence have significant impacts on users’ intention to use the new learning management system.     

Factors explaining adoption and implementation processes for web accessibility standards within eGovernment systems and organizations

Local government organizations such as municipalities often seem unable to fully adopt or implement web accessibility standards even if they are actively pursuing it. Based on existing adoption models, this study identifies factors in five categories that influence the adoption and implementation of accessibility standards for local government websites. Awareness of these factors is important for stakeholders adopting and implementing web accessibility standards. To further develop and understand these factors, this study has identified and interviewed experts in the field of (organizational) accessibility. This has led to an extension of the existing models. The extended model was then validated by interviews with key stakeholders. The outcome of this study places existing adoption models in a new context. The result is an adoption model that contributes better to explaining adoption and implementation processes within eGovernment systems and organizations. This adoption model aims to better help local governments in the identification of factors influencing the actual adoption and implementation of web accessibility standards in their situation. The model explains how factors in the different categories contribute to the adoption and implementation of web accessibility standards. The model may also be applicable to the adoption and implementation of other guidelines and (open) standards within local government.     

Representational Reasoning and Verification

Formal approaches to the design of interactive systems rely on reasoning about properties of the system at a very high level of abstraction. Specifications to support such an approach typically provide little scope for reasoning about presentations and the representation of information in the presentation. In contrast, psychological theories such as distributed cognition place a strong emphasis on the role of representations, and their perception by the user, in the cognitive process. However, the post-hoc techniques for the observation and analysis of existing systems which have developed out of the theory do not help us in addressing such issues at the design stage. Mn this paper we show how a formalisation can be used to investigate the representational aspects of an interface. Our goal is to provide a framework to help identify and resolve potential problems with the representation of information, and to support understanding of representational issues in design. We present a model for linking properties at the abstract and perceptual levels, and illustrate its use in a case study of a ight deck instrument. There is a widespread consensus that proper tool support is a prerequisite for the adoption of formal techniques, but the use of such tools can have a profound effect on the process itself. In order to explore this issue, we apply a higher-order logic theorem prover to the analysis. Received May 1999 / Accepted in revised form July 2000     

Design Factors for Summary Visualization in Visual Analytics

Data summarization allows analysts to explore datasets that may be too complex or too large to visualize in detail. Designers face a number of design and implementation choices when using summarization in visual analytics systems. While these choices influence the utility of the resulting system, there are no clear guidelines for the use of these summarization techniques. In this paper, we codify summarization use in existing systems to identify key factors in the design of summary visualizations. We use quantitative content analysis to systematically survey examples of visual analytics systems and enumerate the use of these design factors in data summarization. Through this analysis, we expose the relationship between design considerations, strategies for data summarization in visualization systems, and how different summarization methods influence the analyses supported by systems. We use these results to synthesize common patterns in real‐world use of summary visualizations and highlight open challenges and opportunities that these patterns offer for designing effective systems. This work provides a more principled understanding of design practices for summary visualization and offers insight into underutilized approaches.     

An empirical study of instructor adoption of web-based learning systems

For years, web-based learning systems have been widely employed in both educational and non-educational institutions. Although web-based learning systems are emerging as a useful tool for facilitating teaching and learning activities, the number of users is not increasing as fast as expected. This study develops an integrated model of instructor adoption of web-based learning systems by incorporating existing literature and multiple empirically verified theories, including the technology acceptance model and DeLone and McLean’s information system success model. Survey data collected from 268 university instructors were examined using structural equation modeling to verify the proposed theoretical model. The research results further illuminate the factors that explain and predict the instructor adoption of web-based learning systems. Implications of this study are also discussed.     

A critical review of the systems approach within patient safety research

The application of concepts, theories and methods from systems ergonomics within patient safety has proved to be an expanding area of research and application in the last decade. This paper aims to take a step back and examine what types of research have been conducted so far and use the results to suggest new ways forward. An analysis of a selection of the patient safety literature suggests that research has so far focused on human error, frameworks for safety and risk and incident reporting. The majority of studies have addressed system concerns at an individual level of analysis with only a few analysing systems across multiple system boundaries. Based on the findings, it is argued that future research needs to move away from a concentration on errors and towards an examination of the connections between systems levels. Examples of how this could be achieved are described in the paper. The outcomes from the review of the systems approach within patient safety provide practitioners and researchers within health care (e.g. the UK National Health Service) with a picture of what types of research are currently being investigated, gaps in understanding and possible future ways forward.     

Market Dynamics and Local Policy Choices for Converged Systems: Case Study of Integrated Telecommunication Design and Deployment

Researchers have cogently presented the technical case for converged telecommunications systems. However, it is not clear how market-based telecommunications providers and local communities are embracing this technical argument as they design and adopt new telecommunication systems. This paper uses a case study approach to examine market and policy dynamics influencing converged network deployment in a mixed commercial and residential environment. Specifically, the article presents the overall telecommunications design and then analyzes several implementation alternatives proposed for a major urban redevelopment project in the greater Denver metropolitan area. These alternatives range from more traditional telecommunications solutions to fully converged networks. Based on this review, the paper analyzes the role of a layered policy approach to telecommunications regulation at the local level and how interoperability serves as a mediating condition before market convergence is achieved. Finally, the paper addresses public policy implications for encouraging adoption of fiber-IP based networks as well as research directions for assessing metropolitan adoption of converged systems.     

IPEAS：适用于建设项目经济评价的决策支持系统

建立有效的建设项目经济评价决策支持系统对于科学决策，减少投资失误有重要意义，本文介绍了一个新型建设项目评价决策支持系统ＩＰＥＡＳ的开发方法，体系结构设计及实现，并对如何利用ＩＰＥＡＳ进行经济评价决策活动作了描述，最后，本文总结了ＩＰＥＡＳ区虽于以往系统的显著优点。     

Secrets to success and fatal flaws: the design of large-display groupware

Research in the field of large-display groupware applications has yet to yield a killer app, a common look and feel for applications, or a set of broadly applicable design principles. It's therefore difficult to understand what constitutes a successful large-display groupware application and what affects their adoption. Although large-display groupware faces many of the same adoption and use challenges as conventional desktop groupware, how people perceive and interact with large-display groupware yields some unique challenges. We've built and evaluated several large-display groupware systems that address various workgroups, functions, and environments. This experience has given us broad expertise regarding the social dynamics and technical challenges surrounding large-display groupware's design. To enhance our understanding of these challenges, we've also undertaken a broad survey of existing large-display groupware systems to understand how their purpose, design, and deployment affect the success of their integration into everyday tasks and practices.     

Identification of UX dimensions for incident reporting systems with mobile applications in urban contexts: a longitudinal study

Incident reporting systems enable end-users to report problems that they have experienced in their working activities to authorities. Such applications are sought to sense the quality of the environment, thus enabling authorities to promote safety and well-being among citizens. Many governments are now promoting the use of mobile applications allowing citizens to report incidents in their neighbourhood to the administration. Nonetheless, it is not clear which user experience dimensions affect the adoption of incident reporting systems, and to what extent anticipated use of the system (anticipated UX) is a determinant for predicting the user experience with the final application. In order to understand how citizens perceive incident reporting systems and which factors affect the user experience (UX), we have performed empirical studies including interviews in early phases of the development process and empirical user testing of advanced prototypes. In this paper, we present the results of a longitudinal study on the evolution of the perception of UX dimensions along the development process, from interviews to running prototypes. Hereafter, we describe the method that has been used for coding the findings of these empirical studies according to six UX dimensions (including visual and aesthetic experience, emotions, stimulation, identification, meaning & value and social relatedness/co-experience). Moreover, we describe how the findings have been associated with users’ tasks. The findings from interviews and user testing indicate that whilst the perceived importance of some UX dimensions (such as identification and meaning & value) remains similar over time, other dimensions such as stimulation and emotions do evolve. Beyond the practical implications of this study for the design of incident reporting systems, this work presents an approach that allows comparing the results of UX assessments in different phases of the process.     

The social and political construction of technological frames

It is widely accepted that the successful adoption of an information system depends to a great extent on users' perceptions of the information system. It follows then that an understanding of users' cognitive frames should be a key factor in managing the adoption of information systems. To reach such an understanding is not an easy task as cognitive frames are dynamic phenomena. For example, what an individual perceives as ‘ease of use’ and ‘usefulness’ may depend not only on intrinsic qualities of the information system but also on the changing contexts in which the information system is evaluated. This work argues that the management of information systems' adoption is a social and political process in which stakeholders frame and reframe their perceptions of an information system. A case study carried out in a European bank illustrates how the Bank's technical team influenced users' technological frames, including those of senior management in order to ensure a smooth implementation process. In conclusion, the paper introduces a set of theoretical propositions relating to the social and political processes that occur during information systems adoption.     

一种基于MT-波波器的连续自适应反推控制的数字实现方法

研究了基于MT-滤波器的连续自适应反推控制的数字实现问题.首先用δ-算子将连 续系统离散化.利用MT-滤波器和反推设计方法给出了自适应反推控制器的设计,然后分别 分析了离散和混杂自适应控制系统的稳定性和跟踪性能.同已有文献相比,本文的主要工作在 于:1)基于MT-滤波器的离散自适应反推控制器的设计;2)误差系统状态向量的构造.由于 MT-滤波器的阶次比K-滤波器的阶次低,因此,误差系统的构造更加复杂,这也使得适应系统 的稳定性分析更加困难.     

Error detection: a study in anaesthesia

Although error has been shown as the main cause of accidents in complex systems, little attention has been paid to error detection. However, reducing the consequences of error depends largely on error detection. The goal of this paper is to synthesize the existing scientific knowledge on error detection, mostly based on studies conducted in laboratory or self reporting and to further knowledge through the analysis of a corpus of cases collected in a complex system, anaesthesia. By doing this, this paper is better able to describe how this knowledge can be used to improve understanding of error detection modes. An anaesthesia accident reporting system developed and organized at two Belgian University Hospitals was used in order to collect information about the error detection patterns. Results show that detection of errors principally occurred through the standard check (routine monitoring of the environment). Significant relationships were found between the type of error and the error detection mode, and between the type of error and the training level of the anaesthetist who committed the error.     

The longitudinal impact of enterprise system users’ pre-adoption expectations and organizational support on post-adoption proficient usage

Although enterprise systems (ES) are ubiquitous, many firms report less than stellar payoffs from these costly investments, with underutilization often attributed to failures in the implementation process. Unfortunately, research has not provided sufficient insights into these failures, in part because it has focused on actual usage, as opposed to proficient usage, as the benchmark for successful implementation. Moreover, research has not generally examined how the adoption process unfolds over time, thus overlooking potential underlying mechanisms that may help explain how adopters achieve proficiency. To begin addressing these shortcomings, we study how adopters’ pre-adoption expectations, enacted over time, can influence their post-adoption proficiency, by shaping how and why they spend time using the system during the adoption period. We analyzed time-lagged survey data from 153 financial analysts, required to adopt new ES-based software, at a multinational bank. We found that adopters who hold pre-adoption expectations reflecting greater internal and external motives to adopt the system as well as systematically integrate it into their work routines are more apt to use the system in ways that enhance their cumulative knowledge of it, and subsequently develop higher levels of proficiency post-adoption. Moreover, greater organizational support enhanced the impact of adopters’ expectations on proficiency, except when their actual use is low in which case organizational support had an adverse effect.     

Evaluating recommender systems from the user’s perspective: survey of the state of the art

A recommender system is a Web technology that proactively suggests items of interest to users based on their objective behavior or explicitly stated preferences. Evaluations of recommender systems (RS) have traditionally focused on the performance of algorithms. However, many researchers have recently started investigating system effectiveness and evaluation criteria from users?? perspectives. In this paper, we survey the state of the art of user experience research in RS by examining how researchers have evaluated design methods that augment RS??s ability to help users find the information or product that they truly prefer, interact with ease with the system, and form trust with RS through system transparency, control and privacy preserving mechanisms finally, we examine how these system design features influence users?? adoption of the technology. We summarize existing work concerning three crucial interaction activities between the user and the system: the initial preference elicitation process, the preference refinement process, and the presentation of the system??s recommendation results. Additionally, we will also cover recent evaluation frameworks that measure a recommender system??s overall perceptive qualities and how these qualities influence users?? behavioral intentions. The key results are summarized in a set of design guidelines that can provide useful suggestions to scholars and practitioners concerning the design and development of effective recommender systems. The survey also lays groundwork for researchers to pursue future topics that have not been covered by existing methods.     

An incremental neural learning framework and its application to vehicle diagnostics

This paper presents a framework for incremental neural learning (INL) that allows a base neural learning system to incrementally learn new knowledge from only new data without forgetting the existing knowledge. Upon subsequent encounters of new data examples, INL utilizes prior knowledge to direct its incremental learning. A number of critical issues are addressed including when to make the system learn new knowledge, how to learn new knowledge without forgetting existing knowledge, how to perform inference using both the existing and the newly learnt knowledge, and how to detect and deal with aged learnt systems. To validate the proposed INL framework, we use backpropagation (BP) as a base learner and a multi-layer neural network as a base intelligent system. INL has several advantages over existing incremental algorithms: it can be applied to a broad range of neural network systems beyond the BP trained neural networks; it retains the existing neural network structures and weights even during incremental learning; the neural network committees generated by INL do not interact with one another and each sees the same inputs and error signals at the same time; this limited communication makes the INL architecture attractive for parallel implementation. We have applied INL to two vehicle fault diagnostics problems: end-of-line test in auto assembly plants and onboard vehicle misfire detection. These experimental results demonstrate that the INL framework has the capability to successfully perform incremental learning from unbalanced and noisy data. In order to show the general capabilities of INL, we also applied INL to three general machine learning benchmark data sets. The INL systems showed good generalization capabilities in comparison with other well known machine learning algorithms.     

Manipulating user resistance to large-scale information systems through influence tactics

This study examines how influence tactics can be used to manipulate user resistance and subsequent usage behaviors in the context of large-scale, newly implemented information systems (IS). To do so, we integrate the theory of interpersonal influence and leadership, adaptive structuration theory, and the literature on user resistance and behavioral IS theories, and develop a comprehensive theoretical model anchored in (a) social influence tactics, (b) IT artifact perceptions, and (c) user resistance and subsequent behaviors. The resultant theoretical model explains how influence tactics modulate user perceptions, user resistance to the system, and ultimately the unfaithful use of the system. This model is tested in the context of an electronic medical record (EMR) system implementation, with a sample of 442 clinicians who were exposed to various influence tactics and with the use of SEM techniques. The results indicate that certain influence tactics are beneficial in reducing user resistance while others can unintentionally increase resistance. Resistance, in turn, drives adaptive user behaviors in the form of unfaithful use of the system. Thus, it is possible to manipulate resistance and resultant adaptive behaviors through influence tactics, without necessarily altering the IT artifact. This is particularly important, as many off-the-shelf IT artifacts cannot be substantially modified.     

Studying the impact of interoperable electronic health records on workflow in ambulatory care

Many of the proposed benefits of health information systems, particularly those regarding efficiency, are assumed to be caused by changes in clinical provider and staff workflow. Assessing the extent to which electronic health records (EHRs) are having the expected effects and identifying barriers to anticipated improvements requires a detailed understanding of how such systems affect day-to-day work activities. This study utilized interviews and observations to develop prototypical workflow models of day-to-day activities in ambulatory practices, allowing activity changes due to the implementation of EHRs with varying levels of interoperability to be identified. Primary and specialty care practices from a multi-county region were sampled. Results showed that EHRs did not consistently improve efficiency, but variously reduced, added, or simply changed work tasks. The impact depended on the work process, level of interoperability, and type of provider involved, as well as aspects of the user interface design. Additionally, implementing EHR systems did not eliminate the use of paper from work processes. Implications for successful implementation and design of EHR systems are provided.Relevance to industryEffectively designing and implementing health IT systems in clinical settings requires an understanding of how the IT system will impact, and be integrated with, existing work activities, and how these impacts may depend on the level of interoperability achieved by the IT system.