Safety risks associated with the lack of integration and interfacing of hospital health information technologies: a qualitative study of hospital electronic prescribing systems in England

Abstract

Background Substantial sums of money are being invested worldwide in health information technology. Realising benefits and mitigating safety risks is however highly dependent on effective integration of information within systems and/or interfacing to allow information exchange across systems. As part of an English programme of research, we explored the social and technical challenges relating to integration and interfacing experienced by early adopter hospitals of standalone and hospital-wide multimodular integrated electronic prescribing (ePrescribing) systems. Methods We collected longitudinal qualitative data from six hospitals, which we conceptualised as case studies. We conducted 173 interviews with users, implementers and software suppliers (at up to three different times), 24 observations of system use and strategic meetings, 17 documents relating to implementation plans, and 2 whole-day expert round-table discussions. Data were thematically analysed initially within and then across cases, drawing on perspectives surrounding information infrastructures. Results We observed that integration and interfacing problems obstructed effective information transfer in both standalone and multimodular systems, resulting in threats to patient safety emerging from the lack of availability of timely information and duplicate data entry. Interfacing problems were immediately evident in some standalone systems where users had to cope with multiple log-ins, and this did not attenuate over time.

Prospective ongoing prescribing error feedback to enhance safety: a randomised controlled trial

“…These merely shift the area where error can and will occur, which still takes place at the so called 'man-machine' interface [10]. Indeed, whilst there is a current NHS England drive towards electronic order entry, ongoing research confirms that errors can and still do occur, with merely the type changing [11].…”

Five key recommendations for the implementation of Hospital Electronic Prescribing and Medicines Administration systems in Scotland

“…Interfacing and data analytics activity should be central to these optimisation efforts, as the HEPMA system that is likely to be deployed in Scotland is an interfacing (rather than an enterprise) solution with limited inbuilt data analytics capability 22. A national data strategy on how this may be achieved should guide ongoing analytics efforts and HEPMA implementation should be viewed as part of the journey towards realising this aim.…”

“…Implementer sites have also over time developed important insights surrounding the limitations of commercial systems and devised strategies to manage potential safety risks associated with altered user workflows and technological interface design 22 , 24 – 26…”

A survey exploring National Health Service ePrescribing Toolkit use and perceived usefulness amongst English hospitals

“…There is an international drive to implement ePrescribing systems in hospitals to improve quality, safety and efficiency associated with the prescribing and administration of medicines 1 – 5. However, there is limited experience in the National Health Service (NHS) on how to procure, implement and optimise these systems.…”