New research examines how IT issues affect care, outcomes

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Three researchers at the Australian Institute for Health Innovation and the University of California at San Francisco have documented potential adverse effects that health information technology has on care delivery and patient outcomes.

Widespread adoption of IT brings many potential benefits, the study authors acknowledge. Yet at the same time, it can increase likelihood of new and often unforeseen errors that affect the safety and quality of clinical care, which could lead to harm.

Mi Ok Kim, professor of epidemiology and biostatistics in California, Farah Magrabi, associate professor of Health Innovation in Australia, and Enrico Coiera, a professor and director at the Centre for Health Informatics in Australia, reviewed results from 34 studies to assess how IT problems affect user interactions, information receipt, decision-making, care processes and patient outcomes.

“Issues with system functionality, include poor user interfaces, fragmented displays and delayed care delivery,” the researchers note. “Issues with system access, system configuration and software updates also delayed care. In 18 studies (53 percent), IT problems were linked to patient harm and death. Near-miss events were reported in 10 studies (29 percent.)”

While previous reviews have examined the overall effect of IT on patient outcomes, less is known about the specific nature of IT problems in clinical settings. Kim, Coiera and Magrabi sought to identify the effects of IT problems as a stage of a chain, from user interaction to clinical outcome.

Contributing factors leading to errors could include training, cognitive load, interruption, multi-tasking, failure to carry out duty, failure to log off, information governance policies and integration with workflows. Omission errors also were considered, such as when an intended action was not executed or an action that was wrong.

The interactions included information received that was wrong, missing, partial or delayed; decisions changed by error, omission, commission or delay; care processes altered by error or delay; and outcomes changed because of a near miss or patient harm.

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In much of the literature on patient safety, patient care information systems (PCIS) are lauded as one of the core building blocks for a safer healthcare system, the researchers note, but they are not convinced.

“We argue that many of these errors are the result of highly specific failures in PCIS design and/or implementation,” Kim, Coiera and Magrabi contend. “We do not focus on errors that are the result of faulty programming or other technical dysfunctions. Hardware problems and software bugs are more common than they should be, especially in a high-risk field such as medicine. However, these problems are well-known and can theoretically be dealt with through testing before implementation.”

They also don’t take into account errors that are a the result of certain dysfunctions, such as doctor refusing to use the information system because that’s not his task or an organization cutting training programs for budget reasons.

“We do focus on those often latent or silent errors that are the result of a mismatch between the functioning of the PCIS and the real-life demands of healthcare,” they conclude. “Such errors are not easily found by a technical analysis of the PCIS design. They can only emerge when the technical system is embedded into a working organization and can vary from one organization to the next. Yet in failing to take seriously well-recognized features of healthcare work, some PCISs are designed or implemented in such a way that error can arguably be expected to result.”

The full report is available here.

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