Sari Palojoki1,2, Kaija Saranto3, Elina Reponen2, Noora Skants2, Anne Vakkuri2, Riikka Vuokko1. 1. Ministry of Social Affairs and Health, P.O. Box 33, Helsinki, FI. 2. HUS Helsinki University Hospital (Peijas Hospital), Department of Anaesthesiology, intensive care and pain medicine, Vantaa, FI. 3. University of Eastern Finland, Faculty of Social Sciences and Business Studies, Kuopio, FI.
Abstract
BACKGROUND: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical healthcare system, but no international consensus exists on a standardized format to enhance collection, analysis, and interpretation of technology-induced errors. OBJECTIVE: The study's first aim was to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). The second aim was to validate the classification by using a data set of incidents during a six-month period immediately after the implementation of a new EHR system. METHODS: The starting point of the classification development was the FIN-TIERA tool, based on research on commonly recognized error types. A multi-professional research team used iterative tests on consensus building to develop a classification. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system to evaluate its characteristics and applicability for purposes of incident reporting. Interrater agreement was applied. RESULTS: The number of EHR-related patient safety incidents during the implementation period (n=501) was fivefold when compared with the pre-implementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for purposes of patient safety incident reporting in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 incident reports; usability problems, 73; documentation problems, 60; and clinical workflow problems, 33. Altogether, 89 reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 74 of the original sample (501) were rejected due to insufficient information, even though the reports were deemed EHR-related. Interrater agreement during the blinded review was 98%. CONCLUSIONS: A new classification for EHR-related patient safety incidents applicable to mature EHRs is presented. The number of EHR-related patient safety incidents during the implementation period possibly reflects patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with EHRs' development cycle. CLINICALTRIAL: N.a.
BACKGROUND: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical healthcare system, but no international consensus exists on a standardized format to enhance collection, analysis, and interpretation of technology-induced errors. OBJECTIVE: The study's first aim was to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). The second aim was to validate the classification by using a data set of incidents during a six-month period immediately after the implementation of a new EHR system. METHODS: The starting point of the classification development was the FIN-TIERA tool, based on research on commonly recognized error types. A multi-professional research team used iterative tests on consensus building to develop a classification. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system to evaluate its characteristics and applicability for purposes of incident reporting. Interrater agreement was applied. RESULTS: The number of EHR-related patient safety incidents during the implementation period (n=501) was fivefold when compared with the pre-implementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for purposes of patient safety incident reporting in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 incident reports; usability problems, 73; documentation problems, 60; and clinical workflow problems, 33. Altogether, 89 reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 74 of the original sample (501) were rejected due to insufficient information, even though the reports were deemed EHR-related. Interrater agreement during the blinded review was 98%. CONCLUSIONS: A new classification for EHR-related patient safety incidents applicable to mature EHRs is presented. The number of EHR-related patient safety incidents during the implementation period possibly reflects patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with EHRs' development cycle. CLINICALTRIAL: N.a.