Table 1.

Knowledge deficits that must be addressed before the emergence of smart environments that facilitate reliable, safe, and compassionate delivery of appropriate interventions to hospitalized patients

Modality	Tools	Impact
Human factors and cognitive science	Surveys Field observation Interview Chart review Standard ontology of error	Identify the human factors that contribute to diagnostic, rescue, or care delivery failures that result in excess morbidity and mortality in the ICU Identify the modes of alert that are the most effective modifi ers of behavior
Ergonomics and engineering	Field observation Process modeling Simulation	Understand processes of care delivery Identify and eliminate environmental factors that impede the delivery of care Identify environmental artifacts that can be re-engineered to force best practice Test the impact of changes in models of care delivery Test the impact on processes of care in high-fidelity simulation environments
Health care informatics and health information technology	Data warehousing Epidemiology Data mining Social networks	Reliably capture digital signatures of patient conditions and provider actions Build real-time feedback to systems of health care delivery (provider and manager) Facilitate the reporting of errors Facilitate secondary data use (for example, the analysis of large data sets from multiple care delivery settings) Dissemination of knowledge
Culture	Reporting error at a local level Coordinated response of ICU community to error Lobbying Developing and enforcing standards	Knowledge of new or unanticipated errors Organized response re-enforces value of reporting Facilitate the implementation of recommendations Reform of incentives Perpetuate the safety culture