Mapping cognitive work: the way out of healthcare IT system failures.

The failure of automation to improve clinical performance is likely rooted in the design concepts on which IT systems are based. Current systems provide clinicians with specific direction about how to care for individual patients. This is much like the specific, detailed, complicated, and narrow trip route driving directions that can be obtained from various web sites. Daily healthcare work rarely has the certainty that makes such directions useful. Rather than directions, useful healthcare automation is likely to have characteristics of a map. Clinicians could use its depictions of available routes, obstacles, and distances between the current and goal locations in order to choose routes and to track progress toward goals. Such representations are likely to be quite different than those currently incorporated in healthcare automation. We demonstrate the concept of creating maps and using constraints as the basis for the design of healthcare automation.