State of the art in clinical informatics: evidence and examples.

OBJECTIVE: The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. METHODS: In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security. RESULTS: Substantial progress has been made in demonstrating that various clinical informatics methodologies and applications improve the structure, process, and outcomes of various facets of the healthcare system. CONCLUSION: Over the coming years, much more will be expected from the field. As we move past the "early adopters" in Rogers' diffusion of innovations' curve through the "early majority" and into the "late majority," there will be a crucial need for new research methodologies and clinical applications that have been rigorously demonstrated to work (i.e., to improve health outcomes) in multiple settings with different types of patients and clinicians.

Shift changes, updates, and the on-call architecture in space shuttle mission control.

In domains such as nuclear power, industrial process control, and space shuttle mission control, there is increased interest in reducing personnel during nominal operations. An essential element in maintaining safe operations in high risk environments with this 'on-call' organizational architecture is to understand how to bring called-in practitioners up to speed quickly during escalating situations. Targeted field observations were conducted to investigate what it means to update a supervisory controller on the status of a continuous, anomaly-driven process in a complex, distributed environment. Sixteen shift changes, or handovers, at the NASA Johnson Space Center were observed during the STS-76 Space Shuttle mission. The findings from this observational study highlight the importance of prior knowledge in the updates and demonstrate how missing updates can leave flight controllers vulnerable to being unprepared. Implications for mitigating risk in the transition to 'on-call' architectures are discussed.

Voice loops as coordination aids in space shuttle mission control.

Voice loops, an auditory groupware technology, are essential coordination support tools for experienced practitioners in domains such as air traffic management, aircraft carrier operations and space shuttle mission control. They support synchronous communication on multiple channels among groups of people who are spatially distributed. In this paper, we suggest reasons for why the voice loop system is a successful medium for supporting coordination in space shuttle mission control based on over 130 hours of direct observation. Voice loops allow practitioners to listen in on relevant communications without disrupting their own activities or the activities of others. In addition, the voice loop system is structured around the mission control organization, and therefore directly supports the demands of the domain. By understanding how voice loops meet the particular demands of the mission control environment, insight can be gained for the design of groupware tools to support cooperative activity in other event-driven domains.