Ethical and Legal Issues in the Use of Health Information Technology to Improve Patient Safety

Abstract Background Although electronic health records (EHRs) are designed to improve patient safety, they have been associated with serious patient harm. An agreed-upon and standard taxonomy for classifying health information technology (HIT) related patient safety events does not exist. Objectives We aimed to develop and evaluate a taxonomy for medication-related patient safety events associated with HIT and validate it using a set of events involving pediatric patients. Methods We performed a literature search to identify existing classifications for HIT-related safety events, which were assessed using real-world pediatric medication-related patient safety events extracted from two sources: patient safety event reporting system (ERS) reports and information technology help desk (HD) tickets. A team of clinical and patient safety experts used iterative tests of change and consensus building to converge on a single taxonomy. The final devised taxonomy was applied to pediatric medication-related events assess its characteristics, including interrater reliability and agreement. Results Literature review identified four existing classifications for HIT-related patient safety events, and one was iteratively adapted to converge on a singular taxonomy. Safety events relating to usability accounted for a greater proportion of ERS reports, compared with HD tickets (37 vs. 20%, p = 0.022). Conversely, events pertaining to incorrect configuration accounted for a greater proportion of HD tickets, compared with ERS reports (63 vs. 8%, p < 0.01). Interrater agreement (%) and reliability (kappa) were 87.8% and 0.688 for ERS reports and 73.6% and 0.556 for HD tickets, respectively. Discussion A standardized taxonomy for medication-related patient safety events related to HIT is presented. The taxonomy was validated using pediatric events. Further evaluation can assess whether the taxonomy is suitable for nonmedication-related events and those occurring in other patient populations. Conclusion Wider application of standardized taxonomies will allow for peer benchmarking and facilitate collaborative interinstitutional patient safety improvement efforts.

Download Full-text

Integrating and safeguarding care: The potential role of health information technologies

International Journal of Care Coordination ◽

10.1177/2053434517715781 ◽

2017 ◽

Vol 20 (3) ◽

pp. 112-118 ◽

Cited By ~ 5

Author(s):

Melissa Desmedt ◽

Sam Pless ◽

Ezra Dessers ◽

Dominique Vandijck

Keyword(s):

Information Technology ◽

Patient Safety ◽

Integrated Care ◽

Health Information Technology ◽

Health Information ◽

Information Technologies ◽

Improve Patient Safety ◽

Chronic Patients ◽

Health And Social Care

The increasing burden of chronic diseases is one of the greatest challenges healthcare systems globally are facing. Across the world, compelling demands can be found for a fundamental shift in the organisation of health and social care to meet the needs of chronic patients. Integrated care has gathered momentum to overcome fragmentation of care in order to create care systems which are demand-driven, client-centred and cost-conscious. Health information technology – often referred to as eHealth – is usually considered to be an essential building brick of integrated care. Moreover, health information technology is said to hold potential for improving patient safety in chronic care settings. The current perspective paper explores the role of health information technology in integrating and safeguarding care. We argue that health information technology – which supports integrated care – may create optimal conditions to improve patient safety, but only when well-implemented, state-of-the-art technologies are used.

Download Full-text

Identifying Safety Hazards Associated With Intravenous Vancomycin Through the Analysis of Patient Safety Event Reports

Patient Safety ◽

10.33940/data/2020.3.3 ◽

2020 ◽

pp. 31-47

Author(s):

Adam Krukas ◽

Ella Franklin ◽

Chris Bonk ◽

Jessica Howe ◽

Ram Dixit ◽

...

Keyword(s):

Information Technology ◽

Patient Safety ◽

Health Information Technology ◽

Health Information ◽

Assessment Tool ◽

Improve Patient Safety ◽

Close Monitoring ◽

Safety Hazards ◽

Safety Issues ◽

Safety Event

Intravenous (IV) vancomycin is one of the most commonly used antibiotics in U.S. hospitals. There are several complexities associated with IV vancomycin use, including the need to have an accurate patient weight for dosing, to provide close monitoring to ensure appropriate drug levels, to monitor renal function, and to continue delivery of the medication at prescribed intervals. There are numerous healthcare system factors, including workflow processes, policies, health information technology, and clinical knowledge that impact the safe use of IV vancomycin. Past literature has identified several safety hazards associated with IV vancomycin use and there are some proposed solutions. Despite this literature, IV vancomycin–related safety issues persist. We analyzed patient safety event reports describing IV vancomycin–related issues in order to identify where in the medication process these issues were appearing, the type of medication error associated with each report, and general contributing factor themes. Our results demonstrate that recent safety reports are aligned with the issues already identified in the literature, suggesting that improvements discussed in the literature have not translated to clinical practice. Based on our analysis and current literature, we have developed a shareable infographic to improve clinician awareness of the complications and safety hazards associated with IV vancomycin and a self-assessment tool to support identification of opportunities to improve patient safety during IV vancomycin therapy. We also recommend development of clear guidelines to optimize health information technology systems to better support safe IV vancomycin use.

Download Full-text

Reporting of health information technology system-related patient safety incidents: The effects of organizational justice

Safety Science ◽

10.1016/j.ssci.2021.105450 ◽

2021 ◽

Vol 144 ◽

pp. 105450

Author(s):

Kia Gluschkoff ◽

Anu Kaihlanen ◽

Sari Palojoki ◽

Elina Laukka ◽

Hannele Hyppönen ◽

...

Keyword(s):

Information Technology ◽

Patient Safety ◽

Organizational Justice ◽

Health Information Technology ◽

Health Information ◽

Technology System ◽

Patient Safety Incidents ◽

Information Technology System

Download Full-text

Health Informatics in Developing Countries: A Review of Unintended Consequences of IT Implementations, as They Affect Patient Safety and Recommendations on How to Address Them

Yearbook of Medical Informatics ◽

10.1055/s-0038-1641611 ◽

2016 ◽

Vol 25 (01) ◽

pp. 70-72 ◽

Cited By ~ 1

Author(s):

A. Almerares ◽

D. Luna ◽

A. Marcelo ◽

M. Househ ◽

H. Mandirola ◽

...

Keyword(s):

Information Technology ◽

Developing Countries ◽

Patient Safety ◽

Health Information Technology ◽

Health Information ◽

Health Informatics ◽

Healthcare Organization ◽

Unintended Consequences ◽

Alert Fatigue ◽

Available Information

SummaryBackground: Patient safety concerns every healthcare organization. Adoption of Health information technology (HIT) appears to have the potential to address this issue, however unanticipated and undesirable consequences from implementing HIT could lead to new and more complex hazards. This could be particularly problematic in developing countries, where regulations, policies and implementations are few, less standandarized and in some cases almost non-existing.Methods: Based on the available information and our own experience, we conducted a review of unintended consequences of HIT implementations, as they affect patient safety in developing countries.Results: We found that user dependency on the system, alert fatigue, less communications among healthcare actors and workarounds topics should be prioritize. Institution should consider existing knowledge, learn from other experiences and model their implementations to avoid known consequences. We also recommend that they monitor and communicate their own efforts to expand knowledge in the region.

Download Full-text

Health information technology adoption: effects on patient safety and quality of care

International Journal of Healthcare Technology and Management ◽

10.1504/ijhtm.2015.070519 ◽

2015 ◽

Vol 15 (1) ◽

pp. 31 ◽

Cited By ~ 2

Author(s):

Binyam K. Seblega ◽

Ning Jackie Zhang ◽

Thomas T.H. Wan ◽

Lynn Y. Unruh ◽

Anastasia Miller

Keyword(s):

Information Technology ◽

Patient Safety ◽

Quality Of Care ◽

Technology Adoption ◽

Health Information Technology ◽

Health Information ◽

Information Technology Adoption

Download Full-text

Health Information Technology

Healthcare Administration ◽

10.4018/978-1-4666-6339-8.ch001 ◽

2015 ◽

pp. 1-22

Author(s):

Patrick Albert Palmieri ◽

Lori T. Peterson ◽

Miguel Noe Ramirez Noeding

Keyword(s):

Information Technology ◽

Patient Safety ◽

Organizational Development ◽

Health Information Technology ◽

Health Information ◽

Development Strategy ◽

Financial Viability ◽

System Failure ◽

Healthcare Organizations ◽

Safety Concerns

Healthcare organizations are increasingly willing to develop more efficient and higher quality processes to combat the competition and enhance financial viability by adopting contemporary solutions such as Health Information Technology (HIT). However, technological failures occur and represent a contemporary organizational development priority resulting from incongruent organization-technology interfaces. Technologically induced system failure has been defined as technological iatrogenesis. The chapter offers the Healthcare Iatrogenesis Model as an organizational development strategy to guide the responsible implementation of HIT projects. By recognizing the etiology of incongruent organizational interfaces and anticipating patient safety concerns, leaders can proactively respond to system limitations and identify hidden process instabilities prior to costly and consequential catastrophic events.

Download Full-text

Responding to health information technology reported safety events: Insights from patient safety event reports

Journal of Patient Safety and Risk Management ◽

10.1177/2516043519847330 ◽

2019 ◽

Vol 24 (3) ◽

pp. 118-124 ◽

Cited By ~ 2

Author(s):

Katharine T Adams ◽

Tracy C Kim ◽

Allan Fong ◽

Jessica L Howe ◽

Kathryn M Kellogg ◽

...

Keyword(s):

Information Technology ◽

Patient Safety ◽

Health Information Technology ◽

Health Information ◽

Healthcare Systems ◽

Healthcare Staff ◽

Or Education ◽

Training And Education ◽

Safety Event ◽

Policy Information

Objective We analyzed the described resolutions of patient safety event reports related to health information technology to determine how healthcare systems responded to these events, recognizing that certain types of solutions such as training and education have a limited impact. Methods A large database of over 1.7 million patient safety event reports was filtered to include those identified by the reporter as being related to health information technology. The resolution text was manually reviewed and coded into one or more of four categories: No Resolution, Training/Education, Policy, Information Technology-oriented solution. Results Most events (64%) did not include a resolution. Of those that did, Training/Education was the most commonly reported single or component of a multi-pronged solution (55%), followed by Information Technology (45%). Only 59 events (6% of resolutions) described more than one method of resolution. Conclusion Health information technology-related patient safety event resolutions most often described a solution that suggested additional training or education for healthcare staff, despite the recognized limitations of training and education in resolving these events. Few events suggested multiple resolution methods. Ensuring health information technology-related events are resolved and incorporate effective solutions should be a continued focus area for healthcare systems.

Download Full-text