Identifying and characterizing system issues of health information technology in medical imaging as a basis for recommendations

Nilsson

et al. 2022

DIGITAL HEALTH

Self Cite

Objective This study explored the Swedish digital health testbeds through the lens of complexity science. Methods The purposive sampling was used to identify 38 digital health testbed organizations to conduct interviews in written or audio-conferencing. The interview responses were aggregated and analyzed using thematic analysis. The themes were mainly generated through complexity theory and the principles of complex adaptive systems. Results Fifteen testbed organizations responded, comprising 13 written responses and two audio-conferencing. Five main theoretical themes were generated: agents and diversity, connections and communication, adaptation and learning, perturbations, and path dependence. Agents and diversity depicted different types of testbeds, stakeholders and innovation, and the primary function and purpose of the testbeds. Various factors enhancing connections and communications among multiple stakeholders were identified, such as the quality of e-health solutions and the 2030 Agenda for Sustainable Development. Some adaptation and learning factors, such as internal reorganization, sharing and creating learning opportunities, and additional funding, guaranteed the sustainability of testbeds. Perturbations were characterized by two factors: non-linear interactions – lack of commitment and transparency in stakeholders' engagement, and uncertainty about testbed definitions and concepts. Path dependence highlighted the importance of history, such as previous positive and negative experiences. Conclusion This study provided insights into testbeds' organization, their functions, how various aspects were challenged, and how they adapted to overcome and improve the system issues. Identifying the stakeholders and relevant factors, commissioning an evaluation, backing up with a contingency plan, securing adequate funding, and disseminating the findings can improve the testbeds' design and implementation.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Digital Health Testbeds in Sweden: An exploratory study

Nilsson

et al. 2022

DIGITAL HEALTH

Self Cite

“…The issues of data integrity and the transfer of historical records to a new system have also been technically challenging, which were left undetected for a long period. 35 , 36 Therefore, harmonising HIT systems is critically important, particularly when a component of the system, a version of the system, or the entire system is obtained from multiple vendors. For example, the configuration of the EMR should be in synchrony with the e-prescribing system for continuous management of the clinical workload.…”

Section: Recommendationsmentioning

confidence: 99%

“…These systems should be interoperable and communicable, ensuring access to clinical studies or patient records to and from each other. 35 , 44 Moreover, the complex nature of the healthcare system always brings about new HIT functionalities along with the modules/components of the system and the standalone applications. These system modules and applications must be interfaced appropriately with the existing system, and the whole process of interfacing must be error-free.…”

Section: Recommendationsmentioning

confidence: 99%

“… 33 Anecdotally, the healthcare organisations in Sweden are confronting similar incidents as those reported in the USA, 34 the UK, 32 and Australia. 35 , 36 Therefore, we intended to collect, classify and analyse incident reports related to e-prescribing systems that would help devise preventive and corrective strategies as recommendations.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Issues with the Swedish e-prescribing system – An analysis of health information technology-related incident reports using an existing classification system

Hammar

2022

DIGITAL HEALTH

Objective To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges. Methods A number of health information technology-related incidents were collected retrospectively from various sources using purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents ( n = 24) were subjected to an existing framework, i.e., the Health Information Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis. Results Several types of software-related issues ( n = 22) were identified: system configuration, interface with other software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges. Conclusions This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.

Characterizing patient details-related challenges from health information technology-related incident reports from Swedish healthcare

Pan

Nilsson

2023

Preprint

This study examined health information technology-related (HIT) incidents to identify patient details-related issues, their association with contributing factors, and outcomes. Sources of information comprised retrospectively collected incident reports (n=95) using two sampling methods, i.e., purposive and snowball sampling. The reports were collected in two formats – interviews (written and telephone) and/or a set of already existing reports from the local database. The incident reports were analyzed using both the inductive method (thematic analysis) and the deductive approach using an existing framework, i.e., the International Classification for Patient Safety. The studies identified 90 incidents with 120 patient details-related issues—categorized as either information-related (48%) or documentation-related (52%) problems; around two-thirds of the 120 issues were characterized by human factors. Of the total sample, 87 contributing factors were identified, of which "medical device/system" (45%) and "documentation" (20%) were the most common contributing factors. Of 90 incidents, more than half (59%) comprised patient-related outcomes—patient inconvenience (47%) and patient harm (12%) and the remaining 41% (n=37) included staff or organization-related outcomes. The study confirms that patient details-related problems with HIT systems were more likely to affect patient care delivery – more than half of the incidents resulted in patient-related outcomes, namely patient inconvenience and patient harm, including disease risks, severe health deterioration, injury, and even patient death. Incidents associated with patient details can cause deleterious effects; therefore, characterizing them should be a routine part of clinical practice to improve the constantly changing healthcare system.