Ndabu Theophile, Mulgund Pavankumar, Sharman Raj, Singh Ranjit
Department of Management Science and Systems, School of Management, State University of New York at Buffalo, Buffalo, NY, United States.
School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, United States.
JMIR Hum Factors. 2021 Feb 5;8(1):e21884. doi: 10.2196/21884.
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.
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.
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.
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.
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.
健康信息技术（HIT）已在医院环境中广泛应用，有助于提高患者安全。然而，许多归因于信息技术（IT）的医疗差错对患者安全产生了负面影响。许多差错持续出现，这提醒人们，HIT软件测试和验证在确保医疗保健机构内软件无差错运行方面并不充分。
本试点研究旨在使用社会技术框架的扩展版本对医院环境中与技术相关的医疗差错进行分类，以了解临床和技术利益相关者对这些差错潜在原因的认知存在的显著差异。本文还提供了一些预防未来差错的建议。
从主要健康数据库中确定的先前研究中收集医疗差错。从主列表中，我们选择了发生在医院环境中的差错。对5名医疗专业人员和6名IT专业人员进行了半结构化访谈，以将这些事件映射到扩展社会技术框架的不同维度上。
在2319篇已识别的出版物中，36篇被纳入综述。在收集的67个差错中，12个发生在医院环境中。分类显示了IT专业人员和医疗专业人员在医疗差错根本原因观点上存在的“鸿沟”。IT专家认为技术是大多数差错的根源，并提出的解决方案大多是技术性的。然而，临床医生将差错根源归因于人员、流程和环境维度。例如，对于“在错误窗口中复制粘贴图表：以前，你不会轻易意外进入别人的图表……因为你必须拉出图表并打开它”这一差错，医学专家强调了环境问题，包括医疗保健提供者在短时间内接待的患者数量、对新电子病历系统不熟悉、差错发生时护士的轮班情况以及因患者同名导致的混淆。他们强调流程控制，包括失效模式，作为一种潜在的解决方法。相比之下，技术专家讨论了缺乏通知、用户界面不佳和终端用户培训不足是导致这一差错的关键因素。
了解社会技术框架的维度及其与其他维度的相互作用可以指导解决医疗差错的方法选择。这些发现使我们得出结论，设计师不仅需要高度的HIT专业知识，还需要对医疗流程和环境因素有深入的理解。尽管软件开发团队历来将临床医生纳入业务分析师或主题专家以弥合差距，但开发团队通过更深入地接触临床环境将得到更好的服务，从而实现更好的软件设计和实施，并最终提高患者安全。
