Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study

Abstract

ObjectiveHospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies.MethodsWe analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies.ResultsOur dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems—in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks.ConclusionsImperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short- and long-term strategies in terms of the technology and organisation to minimise the unintended safety risks.

Anglicization of hospital information systems: Managing diversity alongside particularity

“…We often observed creation of workarounds 25 , loss of user engagement 26 , and unintended safety threats 27 associated with a range of reasons including lack of Anglicization.…”

Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care?

“…Jean Bousquet, MD (1-3), Ignacio J Ansotegui, MD (4), Josep M Anto, PhD (5)(6)(7)(8), Sylvie Arnavielhe, PhD (9), Claus Bachert, MD (10), Xavier Basagaña, PhD (5,7,8), Annabelle Bédard, PhD (5,7,8), Anna Bedbrook, BSc (2), Matteo Bonini, MD (11), Sinthia Bosnic-Anticevich, PhD (12), Fulvio Braido, MD (13), Vicky Cardona, MD (14), Wienczyslawa Czarlewski, MD (15), Alvaro A Cruz, MD (16), Pascal Demoly, MD (17)(18), Govert De Vries, MSc (19), Stephanie Dramburg, MD (47), Eve Mathieu-Dupas, PhD (9), Marina Erhola, PhD (20), Wytske J Fokkens, MD (21), Joao A Fonseca, MD (22), Tari Haahtela, MD (23), Peter W Hellings, MD (24), Maddalena Illario, MD (25), Juan Carlos Ivancevich, MD (26), Vesa Jormanainen, MD (20), Ludger Klimek, MD (27), Piotr Kuna, MD (28), Violeta Kvedariene, MD (29), Daniel Laune, PhD (9), Désirée Larenas-Linnemann, MD (30), Olga Lourenço, PhD (31), Gabrielle L Onorato, MSc (2), Paolo M Matricardi, MD (32), Erik Melén, MD (33), Joaquim Mullol, MD (34), Nikos G Papa...…”

“…The potential applications and benefits of mHealth are extensive and expanding (4). Implementing mHealth innovations may also have disruptive consequences (5), so it is important to test applicability in each individual situation (6). Appropriately identifying and representing stakeholders' interests and viewpoints in evaluations of mHealth is a critical part of ensuring continued progress and innovation (7).…”

A systematic analysis of the optimization of computerized physician order entry and clinical decision support systems: A qualitative study in English hospitals

“…6 However, recent attempts to implement commercial CPOE/CDS systems have struggled to replicate these benefits and have in some cases yielded unintended consequences where, for example, commercial off-the-shelf (COTS) packaged solutions that were not well-aligned with clinical practices undermined improvements and threatened patient safety. [7][8][9] This disparity in implementation outcomes underlines that the procurement of a system is a necessary, but not sufficient condition for successful adoption. Rather, the outcome of an implementation can be contingent on technical, social, and organizational factors.…”

“…Implementation strategies should be long-term-oriented and incorporate considerations for system optimization to address on-going and emerging concerns over a much longer timeframe than anticipated by existing episodic perspectives. 9 The short-term duration of many investments in this field has come into conflict with the long-term development of use and optimization activities, well beyond initial implementation. We therefore stress the need to allocate on-going financial resources and managerial effort to the post-implementation phase, coupled with the need to extend engagement 21 and sustain implementation support team structures to retain and re-use the internal experience and expertise acquired by team members in the course of the implementation journey.…”