According to the human factors paradigm for patient safety, health care work systems and innovations such as electronic medical records do not have direct effects on patient safety. Instead, their effects are contingent on how the clinical work system, whether computerized or not, shapes health care providers’ performance of cognitive work processes. An application of the human factors paradigm to interview data from two hospitals in the Midwest United States yielded numerous examples of the performance-altering effects of electronic medical records, electronic clinical documentation, and computerized provider order entry. Findings describe both improvements and decrements in the ease and quality of cognitive performance, both for interviewed clinicians and for their colleagues and patients. Changes in cognitive performance appear to have desirable and undesirable implications for patient safety as well as for quality of care and other important outcomes. Cognitive performance can also be traced to interactions between work system elements, including new technology, allowing for the discovery of problems with “fit” to be addressed through design interventions.

中文翻译：

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电子病历对认知表现的影响：人为因素范式在患者安全中的应用

根据患者安全的人为因素范式，医疗保健工作系统和电子病历等创新对患者安全没有直接影响。相反，它们的影响取决于临床工作系统（无论是否计算机化）如何塑造医疗保健提供者的认知工作流程绩效。将人为因素范式应用到美国中西部两家医院的访谈数据中，产生了大量电子病历、电子临床文档和计算机化供应商订单输入对绩效影响的例子。调查结果描述了接受采访的临床医生及其同事和患者在认知能力的容易程度和质量方面的改善和下降。认知表现的变化似乎对患者安全以及护理质量和其他重要结果具有可取和不可取的影响。认知表现也可以追溯到工作系统元素之间的相互作用，包括新技术，允许通过设计干预来解决“适合”问题的发现。