Effects of interorganisational information technology networks on patient safety: a realist synthesis

Abstract

ObjectiveHealth services in many countries are investing in interorganisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home.DesignRealist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews.Eligibility criteriaThe coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital.Information sources17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts.OutcomesChanges in patients’ clinical risks.ResultsWe did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks.ConclusionsEmpirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems.PROSPERO registration numberCRD42017073004.

Hidden labour: the skilful work of clinical audit data collection and its implications for secondary use of data via integrated health IT

“…Sociologically-informed and feminist accounts of the creation and recreation of healthcare records paint a similar picture, in which meaningful data emerge from the complex, untidy, heterogeneously-motivated interactions of people and digital programs within socio-cultural, institutional and political systems [ 13 , 21 , 36 , 37 ]. From this angle, Swinglehurst and Greenhalgh [ 21 ] reframe the ‘invisible work’ (p.2) of data collection as knowledge work, which involves ‘an interweaving of tedious activity, mindful judgment and practical reasoning’ (p.2), noting that: Current interest in large datasets and the potential for health data to be put to an ever widening array of secondary uses tends to obscure the socially complex work that lies in the details of how data gets onto the record, and we suggest that this presents an important, often overlooked agenda for research on the quality of health care [ 21 ] .…”

“…However, moves towards fully integrated HIT across which data can be shared have met with mixed results internationally [12][13][14][15][16][17]. From a sociological perspective, Berg and Goorman [18] suggest that the profoundly contextual nature of health information is at the root of such difficulties; it is not simply a commodity which can be transported smoothly from one system to another, provided the correct technological connections are in place.…”