Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study

Abstract

Background Health 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. Objective This 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. Methods Medical 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. Results Of 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. Conclusions Knowledge 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.

Clinical Informatics Team Members’ Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study

“…In addition, this study was situated in a nonacute setting, and therefore, the applicability of our findings is limited as such. However, given the adaptable and codeveloped nature of the processes for learning, it is possible that other health care settings may benefit from using similar approaches [ 45 , 85 ].…”

Classification of Health Information Technology Safety Events in a Pediatric Tertiary Care Hospital

“…However, introducing new technologies into increasingly complex healthcare environments creates new areas of risk and possible harm to patients 1–5 . Patient safety reporting systems are an essential tool for safety improvement in healthcare, and leveraging these systems to identify when HIT may have contributed to potential harm is an important step toward mitigating HIT-related hazards 6–13 …”

“…[1][2][3][4][5] Patient safety reporting systems are an essential tool for safety improvement in healthcare, and leveraging these systems to identify when HIT may have contributed to potential harm is an important step toward mitigating HIT-related hazards. [6][7][8][9][10][11][12][13] Health information technology patient safety event data collected and reported to state agencies are typically derived from hospital safety event reporting systems. 6,7,10,14,15 In a voluntary reporting system, a HIT event may be identified by the person reporting the event, or categorized as HIT related on the back end by a clinical staff member who reviews the event.…”