Cognitive artifacts are created and used to support task performance in many domains. These artifacts may be essential components designed into a process, they may have been created by users as work-arounds to system shortcomings, or they may be extensions to systems that add functionalities to meet evolving needs. Examination of cognitive artifacts may provide insights that complement other cognitive engineering methods such as task analysis. This panel will present findings from study of cognitive artifacts used in high risk domains such as healthcare. Panelists will address questions relating to research methodologies, theoretical frameworks, and design implications, such as: What are the roles of user-designed artifacts for care coordination and patient safety? What can designers learn from artifacts? How can we use artifact analysis to design better health information technologies? Can vendor-designed information tools and user-designed artifacts work in harmony to provide safe care? Panel members will address these questions based on their research studies and experiences within as well as outside the health care area.