A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

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This is a review for Sittig and Singh's 2010 article "A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems."[1]

Introduction and Background

Prior to the development of this model, none existed that took into account all aspects of the complex adaptive healthcare systems that health information technology (HIT) is being implemented in. These complicated systems demanded a better conceptual model for studying the complex relationships between all of the moving parts involved in a health care system equipped with HIT.

Existing models (Henriksen's model, Vincent's framework for analyzing risk and safety, Carayon's SEIPS model, and Harrison's ISTA framework) helped inform the development of this model, but none broke down all aspects of technology individually or included a dimension regarding monitoring or governance structures, which the authors determined were essential when considering this new technology-filled health care system.

Moving Towards a New Socio-technical Model for HIT

This new model was proposed to study the "design, development, use, implementation, and evaluation of HIT."[1] The model is meant to be used by considering each component as well as the ways the components interact with one another.

The 8 Dimensional Socio-technical Model Includes:

  • Hardware and Software Computing Infrastructure: equipment and software used to power, support, and operate clinical applications and devices
  • Clinical Content: textual or numeric data and images that constitute the "language" of clinical applications
  • Computer Interface: all aspects of the computer that users can see, touch, or hear as they interact with it
  • People: everyone who interacts in some way with the system, from the developers to end-users, including potential patient-users
  • Workflow and Communication: processes or steps involved in assuring that patient care tasks are carried out effectively
  • Internal Organizational Policies, Procedures, and Culture: an organization's internal structures, policies, and procedures affect every other dimension in the model.
  • External Rules, Regulations, and Pressures: accounts for the external forces that facilitate or place constraints on the design, development, implementation, use, and evaluation of HIT in the clinical setting.
  • System Measurement and Monitoring: the effects of HIT must be measured and monitored on a regular basis.

Relationships and Interactions between our Model's Components

It is essential that, when studying health information technology, one studies it in the context of the complex adaptive system that it is instead of on its own. The authors posit that one cannot use a hierarchical methodology to study HIT because there is too much interaction amongst system components. No model component can be assessed in isolation. The 8 dimensions must be "studied as multiple, interacting components with non-linear, emergent, dynamic behavior (i.e., small changes in one aspect of the system lead to small changes in other parts of the system under some conditions, but large changes at other times), that often appears random or chaotic."[1]

The New HIT Model in Action in Real-World Settings

The authors provide examples of how they have successfully used this model in their research, from projects that involved HIT design and development (e.g., a CDS intervention) to HIT implementation (e.g., a CPOE system), HIT use, and HIT evaluation.


This model established a new paradigm for studying and evaluating HIT, especially its safe and effective implementation and use in a the complex adaptive health care system that exists today.


This model really set the scene for understanding and improving health information technology safety. Most researchers do not consider the entire system at work when looking at a specific area of HIT, but this model illustrates the importance of considering a wide range of issues and their interactions when evaluating HIT. It provides a much wider angle view and places HIT in the context of a system, which is essential to researchers and end-users alike.

Related articles


  1. 1.0 1.1 1.2 A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems. Sittig, DF and Singh, H. Qual Saf Health Care. 2010 Oct; 19(Suppl 3): i68–i74. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120130/