Abstract
BackgroundHealth information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization.ObjectiveThis pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors.MethodsMedical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework.ResultsOf the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the “gulf” that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error “Copied and pasted charting in the wrong window: Before, you could not easily get into someone else’s chart accidentally...because you would have to pull the chart and open it,” medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error.ConclusionsKnowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety.
Highlights
BackgroundThe widespread use of information technology (IT) has contributed to improved patient safety in the hospital setting [1,2,3,4,5]
Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors
We extracted 67 unique patient safety events from the articles in which 12 specific issues related to IT use in the hospital setting were shortlisted
Summary
The widespread use of information technology (IT) has contributed to improved patient safety in the hospital setting [1,2,3,4,5]. Many different kinds of medical errors attributable to the use of IT in health care have negatively impacted patient safety [6,7]. The number of patients who experience adverse events is estimated to be 40% of all patients who visit primary and ambulatory care [8] These safety events may lead to an extended hospital stay, additional side effects, or distress and in some cases death. Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization
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