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Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study
BACKGROUND: Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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JMIR Publications
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971770/ https://www.ncbi.nlm.nih.gov/pubmed/33544089 http://dx.doi.org/10.2196/21884 |
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author | Ndabu, Theophile Mulgund, Pavankumar Sharman, Raj Singh, Ranjit |
author_facet | Ndabu, Theophile Mulgund, Pavankumar Sharman, Raj Singh, Ranjit |
author_sort | Ndabu, Theophile |
collection | PubMed |
description | BACKGROUND: Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization. OBJECTIVE: This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors. METHODS: Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework. RESULTS: Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the “gulf” that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error “Copied and pasted charting in the wrong window: Before, you could not easily get into someone else’s chart accidentally...because you would have to pull the chart and open it,” medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error. CONCLUSIONS: Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety. |
format | Online Article Text |
id | pubmed-7971770 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-79717702021-03-24 Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study Ndabu, Theophile Mulgund, Pavankumar Sharman, Raj Singh, Ranjit JMIR Hum Factors Original Paper BACKGROUND: Health information technology (HIT) has been widely adopted in hospital settings, contributing to improved patient safety. However, many types of medical errors attributable to information technology (IT) have negatively impacted patient safety. The continued occurrence of many errors is a reminder that HIT software testing and validation is not adequate in ensuring errorless software functioning within the health care organization. OBJECTIVE: This pilot study aims to classify technology-related medical errors in a hospital setting using an expanded version of the sociotechnical framework to understand the significant differences in the perceptions of clinical and technology stakeholders regarding the potential causes of these errors. The paper also provides some recommendations to prevent future errors. METHODS: Medical errors were collected from previous studies identified in leading health databases. From the main list, we selected errors that occurred in hospital settings. Semistructured interviews with 5 medical and 6 IT professionals were conducted to map the events on different dimensions of the expanded sociotechnical framework. RESULTS: Of the 2319 identified publications, 36 were included in the review. Of the 67 errors collected, 12 occurred in hospital settings. The classification showed the “gulf” that exists between IT and medical professionals in their perspectives on the underlying causes of medical errors. IT experts consider technology as the source of most errors and suggest solutions that are mostly technical. However, clinicians assigned the source of errors within the people, process, and contextual dimensions. For example, for the error “Copied and pasted charting in the wrong window: Before, you could not easily get into someone else’s chart accidentally...because you would have to pull the chart and open it,” medical experts highlighted contextual issues, including the number of patients a health care provider sees in a short time frame, unfamiliarity with a new electronic medical record system, nurse transitions around the time of error, and confusion due to patients having the same name. They emphasized process controls, including failure modes, as a potential fix. Technology experts, in contrast, discussed the lack of notification, poor user interface, and lack of end-user training as critical factors for this error. CONCLUSIONS: Knowledge of the dimensions of the sociotechnical framework and their interplay with other dimensions can guide the choice of ways to address medical errors. These findings lead us to conclude that designers need not only a high degree of HIT know-how but also a strong understanding of the medical processes and contextual factors. Although software development teams have historically included clinicians as business analysts or subject matter experts to bridge the gap, development teams will be better served by more immersive exposure to clinical environments, leading to better software design and implementation, and ultimately to enhanced patient safety. JMIR Publications 2021-02-05 /pmc/articles/PMC7971770/ /pubmed/33544089 http://dx.doi.org/10.2196/21884 Text en ©Theophile Ndabu, Pavankumar Mulgund, Raj Sharman, Ranjit Singh. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 05.02.2021. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on http://humanfactors.jmir.org, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Ndabu, Theophile Mulgund, Pavankumar Sharman, Raj Singh, Ranjit Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title | Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title_full | Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title_fullStr | Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title_full_unstemmed | Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title_short | Perceptual Gaps Between Clinicians and Technologists on Health Information Technology-Related Errors in Hospitals: Observational Study |
title_sort | perceptual gaps between clinicians and technologists on health information technology-related errors in hospitals: observational study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971770/ https://www.ncbi.nlm.nih.gov/pubmed/33544089 http://dx.doi.org/10.2196/21884 |
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