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

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. Author SummaryThe rapid advances in HIT systems have made healthcare a truly complex socio-technical system than ever before. No matter what changes are introduced in healthcare, new, unforeseen problems always arise. Our research focuses on improving the already existing HIT systems and the care delivery around those systems by solving the clinical problems we encounter in our day-to-day clinical practice rather than building new technologies. The foundation builds on collecting and analyzing incident reports to illuminate the current challenges of Swedish digital healthcare systems and provide a basis for preventive and corrective strategies, thus improving clinical practice. Although a host of mainly technical problems was expected, around two-thirds of the issues were identified to be generated by failures due to human factors. Therefore, several strategies to mitigate these risks can be implemented, such as training healthcare professionals before integrating new HIT systems and designing out the "error-prone features". Our study provided insight into patient information/documentation-related problems associated with HIT systems and how human and technical factors affect patient care delivery. The analyses may also help the reporters and analysts regarding where preventive and corrective strategies should be addressed to improve the constantly changing healthcare system.