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Many unintended and undesired consequences of Healthcare Information Technologies (HIT) flow from interactions between the HIT and the healthcare organization's sociotechnical system-its workflows, culture, social interactions, and technologies. This paper develops and illustrates a conceptual model of these processes that we call Interactive Sociotechnical(More)
The authors develop a typology of clinicians' workarounds when using barcoded medication administration (BCMA) systems. Authors then identify the causes and possible consequences of each workaround. The BCMAs usually consist of handheld devices for scanning machine-readable barcodes on patients and medications. They also interface with electronic medication(More)
CONTEXT Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of(More)
OBJECTIVE To model inconsistencies or distortions among three realities: patients' physical reality; clinicians' mental models of patients' conditions, laboratories, etc; representation of that reality in electronic health records (EHR). To serve as a potential tool for quality improvement of EHRs. METHODS Using observations, literature, information(More)
In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of(More)
In real world domains, from healthcare to power to finance, computer systems are deployed with the intention of streamlining and improving the activities of human agents in the corresponding non-cyber worlds. However, talking to actual users (instead of just computer security experts) reveals endemic circumvention of the computer-embedded rules.(More)
Security subsystems are often designed with flawed assumptions arising from system designers' faulty mental models. Designers tend to assume that users behave according to some textbook ideal, and to consider each potential expo-sure/interface in isolation. However, fieldwork continually shows that even well-intentioned users often depart from this ideal(More)
Agent-based modeling can serve as a valuable asset to security personnel who wish to better understand the security landscape within their organization, especially as it relates to user behavior and circumvention. In this paper, we argue in favor of cognitive behavioral agent-based modeling for usable security, report on our work on developing an(More)