Behavioral Healthcare Informatics

A colleague of mine recently remarked, “No matter what, it always comes back to people.” Although we were discussing politics, his perspective provided a nice starting point for this review.

The importance of the book’s subject is indisputable. While I was writing this review, Congress substantially restricted the scope of the fledgling Defense Advanced Research Projects Agency Information Awareness Office (which dropped its Orwellian “eye-in-the-pyramid” logo and its Janusian motto, “Knowledge is power”). Contemporaneously, more than 400 physicians petitioned Cedars-Sinai Medical Center to suspend the use of its computerized order entry system, stating that it required excessive work and endangered patient safety (1). The impact of computer technology on our personal and professional lives is pervasive and deserves our informed, proactive attention.

Behavioral informatics has a very small literature and an even smaller useful literature. This book augments the latter category. It is the 11th book in the Health Informatics Series, formerly titled Computers in Health Care. The change in name reflects the recognition that computers are only half of a computers-people dyad. Informatics increasingly addresses both partners in that relationship, as does this book.

The book is divided into five sections: Overview, Clinicians’ Issues, Consumers’ Issues, Informatics and Quality Improvement, and Organizational Issues. While each section is preceded by a brief introduction, the book might have benefited from greater overall editorial integration. It remains more of a collection of discrete chapters, albeit informative ones, than a unified statement. I found some essays (e.g., those in the Overview section) mildly dissatisfying, perhaps because their breadth of scope allowed only a surface view. Others, particularly those in the last section, are more immediately useful.

Infrequently, this book falls prey to prepublication obsolescence, the great curse of computer writing; for example, the information on the Health Insurance Portability and Accountability Act is somewhat outdated. The book commits rare errors of commission (e.g., SETI is not the acronym for “Signs of Extraterrestrial Intelligence”) and omission (e.g., such topics as PDAs, wireless technologies, and computer-assisted therapy receive less coverage than they deserve). Readers interested in pursuing topics in greater depth will find the adequacy of references variable. Overall, however, the book rewards the interested reader.

Perhaps not surprising in a book on behavioral informatics, the best parts of the book are those addressing the human, rather than the technological side of the dyad. For example, the book includes discussions of the importance of user-friendliness concerns in designing computerized decision support systems (p. 58); how psychological ownership of behavioral healthcare systems is crucial to their success (p. 139); why physicians sometimes resist implementation or changes of computer systems, and what to do about that (pp. 140–148); and the dynamics of organizational change management (p. 156).

Both explicitly and implicitly, the book illustrates how we can use computers to enable or to regiment; to individualize or to centralize; to help or to hinder; and to liberate or to control. Computers don’t have that power, nor do they face those choices, but people using computers do. This book helps inform those choices.