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

OBJECTIVE: Health 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, f...

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Autores principales: Keen, Justin, Abdulwahid, Maysam Ali, King, Natalie, Wright, Judy M, Randell, Rebecca, Gardner, Peter, Waring, Justin, Longo, Roberta, Nikolova, Silviya, Sloan, Claire, Greenhalgh, Joanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552839/
https://www.ncbi.nlm.nih.gov/pubmed/33039991
http://dx.doi.org/10.1136/bmjopen-2019-036608
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author Keen, Justin
Abdulwahid, Maysam Ali
King, Natalie
Wright, Judy M
Randell, Rebecca
Gardner, Peter
Waring, Justin
Longo, Roberta
Nikolova, Silviya
Sloan, Claire
Greenhalgh, Joanne
author_facet Keen, Justin
Abdulwahid, Maysam Ali
King, Natalie
Wright, Judy M
Randell, Rebecca
Gardner, Peter
Waring, Justin
Longo, Roberta
Nikolova, Silviya
Sloan, Claire
Greenhalgh, Joanne
author_sort Keen, Justin
collection PubMed
description OBJECTIVE: Health 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. DESIGN: Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. ELIGIBILITY CRITERIA: The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. INFORMATION SOURCES: 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. OUTCOMES: Changes in patients’ clinical risks. RESULTS: We 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. CONCLUSIONS: Empirical 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 NUMBER: CRD42017073004.
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spelling pubmed-75528392020-10-21 Effects of interorganisational information technology networks on patient safety: a realist synthesis Keen, Justin Abdulwahid, Maysam Ali King, Natalie Wright, Judy M Randell, Rebecca Gardner, Peter Waring, Justin Longo, Roberta Nikolova, Silviya Sloan, Claire Greenhalgh, Joanne BMJ Open Health Informatics OBJECTIVE: Health 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. DESIGN: Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. ELIGIBILITY CRITERIA: The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. INFORMATION SOURCES: 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. OUTCOMES: Changes in patients’ clinical risks. RESULTS: We 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. CONCLUSIONS: Empirical 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 NUMBER: CRD42017073004. BMJ Publishing Group 2020-10-10 /pmc/articles/PMC7552839/ /pubmed/33039991 http://dx.doi.org/10.1136/bmjopen-2019-036608 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Health Informatics
Keen, Justin
Abdulwahid, Maysam Ali
King, Natalie
Wright, Judy M
Randell, Rebecca
Gardner, Peter
Waring, Justin
Longo, Roberta
Nikolova, Silviya
Sloan, Claire
Greenhalgh, Joanne
Effects of interorganisational information technology networks on patient safety: a realist synthesis
title Effects of interorganisational information technology networks on patient safety: a realist synthesis
title_full Effects of interorganisational information technology networks on patient safety: a realist synthesis
title_fullStr Effects of interorganisational information technology networks on patient safety: a realist synthesis
title_full_unstemmed Effects of interorganisational information technology networks on patient safety: a realist synthesis
title_short Effects of interorganisational information technology networks on patient safety: a realist synthesis
title_sort effects of interorganisational information technology networks on patient safety: a realist synthesis
topic Health Informatics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552839/
https://www.ncbi.nlm.nih.gov/pubmed/33039991
http://dx.doi.org/10.1136/bmjopen-2019-036608
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