Health Information Technology for Patient Safety Improvement

Introduction

In the United States, healthcare safety is not where it ought to be. Figures from a pair of landmark research works reveal that between 44,000 and 98,000 individuals lose their lives per year within healthcare settings owing to preventable clinical errors. Even using the lower figure, preventable clinical mistakes within healthcare facilities surpass mortality attributed to widely feared risks such as motor vehicle accidents, AIDS, and breast cancer. The term "clinical error" may be described as the non-completion of an action according to plan, or the use of the wrong plan for accomplishing an objective. The issues that most commonly arise while delivering healthcare services include wrong transfusions, adverse medication-related events, surgery-related injuries, wrong-site operations, mistaken patient identity, suicide, pressure ulcers, restraint-linked loss of life or injury, falls, and burns. Error cases with the gravest consequences most commonly transpire in ICUs (intensive care units), emergency rooms, and operating theatres (IOM, 1999).

Many people hold the view that technological advancement means improved efficacy, safety, cost management, and quality of healthcare services. However, some argue that these same advancements can give rise to adverse events and clinical errors. Considering that several million healthcare practitioners worldwide use almost 5,000 kinds of clinical tools and equipment, device-linked issues are to some extent unavoidable. Even so, mistakes and inefficiencies persist within the healthcare domain owing to the low-level technology the sector employs for management. Most healthcare systems across the globe continue to rely on a pen-and-paper system, including those in developed nations such as the United States. This is an obstacle on the path of medical progress and gives rise to inefficiency and waste. Beyond patients bearing the burden through adverse health events and inconvenience, there is also an increase in litigation and administrative costs attributable to such mistakes and inefficiencies (Amit, 2019).

Of particular concern is patient information exchange when patients are transferred between departments or hospitals. Conventionally performed patient record sharing is ineffective and time-consuming, and puts patient data in jeopardy — including risk of data leaks and loss of confidentiality and privacy. Inefficient or incomplete information interchange may be highly dangerous when a patient requires complex or emergency treatment.

This paper therefore argues that a principal means of addressing the above-mentioned medical problems is through the adoption of advanced technology capable of delivering a comprehensive healthcare experience — one that allows diverse participants in the healthcare process (namely physicians, patients, and healthcare insurance and scheme providers) to exchange patient data in a secure and timely manner.

Brief Literature Review

Alotaibi and Federico (2017) state that ever since the IOM (Institute of Medicine) report was published, health IT (HIT) has been created and implemented at a quicker pace, with varying levels of evidence regarding HIT's effect on patient safety. Their review analyzed existing scientific evidence regarding the influence of diverse HITs on patient safety outcomes. It was concluded that HIT gives rise to patient safety improvements through decreasing clinical errors and adverse reactions to medication, in addition to improving adherence to clinical practice guidelines. Furthermore, HIT was identified as a key instrument for improving the safety and quality of healthcare. Hospitals and other healthcare facilities must selectively choose technologies for investment, since evidence reveals that certain technologies have only limited support when it comes to improving patient safety outcomes.

Singh and Sittig (2016) indicate that HIT is capable of bringing about patient safety improvements, though its adoption has resulted in unintended consequences and fresh safety-related concerns. One of the major challenges to improvement of HIT-enabled hospital system safety is the development of effective, practical approaches for measuring safety concerns where HIT intersects with patient safety. As a solution to the basic methodological and theoretical gaps associated with the definition and measurement of HIT-linked patient safety, the authors put forward a novel framework labeled HITS (HIT Safety) measurement, offering a theoretical basis for HIT-linked patient safety improvement, measurement, and monitoring. This framework incorporates sociotechnical as well as CQI (Continuous Quality Improvement) strategies and calls for novel measurement tasks and measures for addressing safety concerns.

Feldman, Buchalter, and Hayes (2018), in their article "Health Information Technology in Healthcare Quality and Patient Safety: Literature Review," conducted a review of peer-reviewed texts dealing with actual HIT employment in the areas of patient safety and healthcare quality. The authors classified 41 research works through inductive thematic analysis with open coding. They utilized three pre-established groups — prevention, action, and identification — and coding generated three additional groups: challenges, location, and outcomes. This research aimed to provide a basis for understanding where to concentrate HIT-linked human and financial resources, as well as what to expect from HIT implementation for patient safety and healthcare quality, since both areas are beginning to adopt HIT to prevent preventable events, take action in case of inevitable problems, and identify preventable events before they develop into actual problems.

Theoretical Perspectives on HIT

Health information technology (HIT) has been conceptualized to cover information technology and associated nomological networks that encompass systems promoting healthcare goals, including CDSS (clinical decision support systems), EHR/EMR (electronic health/medical records), CPOE (computerized physician order entry), and PCHR (personally controlled health records, accessible by patients as well as their physicians in different ways) (Halamka, Mandl, & Tang, 2008), as well as administrative support systems and other information management IT systems. HIT may be distinguished from general IT on account of its particular focus and its more rigorous and constraining standards and frameworks.

AST (Adaptive Structuration Theory) improves IT analysis, particularly in cases of new adoption. Based on Giddens's 1984 Structuration Theory, Poole and DeSanctis (1994) developed adaptations concentrating on intra-organizational social structure and how organizational members' interactions are both shaped by and shape IT utilization. In contrast to AST's emphasis on social structure, TTF (Task-Technology Fit) theory centers on whether IT is properly designed to suit the activity carried out by the individual user. AST is frequently employed for addressing group-level events, while TTF focuses on the individual. Patient care is seldom an individual domain; a group encompassing physicians, nursing staff, other practitioners, administrators, technicians, and, most importantly, the patient engages in information interchange, decision-making, and acting on those decisions. Therefore, AST may be highly applicable to HIT analysis, and TTF may help study the linkages between each of these players and the HIT systems they interact with. These models are considered especially well-suited to HIT analysis (Weigel, Hall, & Landrum, 2009).

HIT in Prevention, Identification, and Action

Health Information Technology for Prevention of Quality and Safety Events

HIT applied to the prevention of safety and quality events involves using HIT to avoid the occurrence of such events altogether. Computerized notifications and alarms can offer key data to support efficient, safe clinical decision-making. These notifications within the context of EHRs represent a standard element of HIT for preventing likely patient safety failures and missed quality events. For instance, immunization notifications have resulted in a twelve percent increase in vaccination administration among healthy children and a twenty-two percent increase among ill children. Additionally, medication notifications have been linked to a twenty-two percent decline in drug prescription errors. Soft stops can offer vital details regarding a likely patient safety or care quality problem and may proffer alternatives, though they generally only require users to acknowledge the notification before proceeding.

Hard stops, by contrast, prevent users from proceeding with interventions or orders that would potentially be harmful to patients. They can allow process continuance, but only when the user takes a necessary major action, such as consulting with a specialist (e.g., a pharmacist). In certain instances, a soft stop can be overruled or ignored on account of problems such as alert fatigue, ineffective interface design, and poor implementation. A hard stop, if properly designed, has proven more effective in altering an unsafe plan or preventing a potentially hazardous intervention.

Health Information Technology for Identification of Quality and Safety Events

HIT applied to the identification of safety and quality events involves using technology to identify such events at the time of their occurrence. Healthcare insurance providers have been progressively pressuring healthcare systems to decrease service provision costs and bring about improvements in patient health outcomes. Such pressure may manifest through tiered reimbursement arrangements and performance benchmarking systems. Increased pressure from payers also takes the shape of non-reimbursed care deemed unnecessary or beyond "standard care." HIT may help isolate EHR patient populations for whom reimbursement may fall below the anticipated figure. An instructive example is hospitalization duration for a given medical procedure. HIT applications may furnish dashboards and reports valuable for decision-making corresponding to reimbursement practices and hospitalization duration trends; however, carefully considering unintended consequences — such as unintentional re-hospitalization — remains imperative.

Health Information Technology for Action in Quality and Safety Events

HIT for safety and quality event-related action involves using HIT to respond to safety and quality events after they have already transpired — specifically, actions taken as a direct result of a recorded event. Action-focused HIT differs from prevention-focused HIT in that the former is a response directly associated with an event that has occurred, while the latter is a preemptive procedure carried out before an event takes place.

Owing to their standardization, a number of medical care pathways lend themselves to clinical decision support, including sepsis management. Despite nearly twenty years of advancement in early sepsis care, outcomes remain poor, with sepsis continuing to be a major cause of global mortality and accounting for considerable morbidity. Consequently, there is growing national impetus to enhance early sepsis detection and treatment. Sepsis patients are among the most critically ill patients hospitalized, and their chances of survival are largely reliant on prompt administration of key interventions and swift assessment of outcomes — for example, intravenous antibiotic administration and aggressive intravenous fluid resuscitation within a single hour of recognition.

A practical challenge for clinicians is distinguishing relevant from irrelevant information. A wide range of laboratory test results may be presented, though in actual clinical practice, only three to four tests typically guide the clinical decision. The challenge lies in distinguishing the signal (vital for that moment) from the noise (unnecessary data for that moment). HIT solutions such as dashboards can help ensure that necessary information is placed in a favorable viewing position, with non-vital information relegated to a secondary position accessible through drill-down navigation.

References

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Med J, 38(12), 1173–1180.

Amit, M. (2019, January 28). 5 problems which healthcare technology can solve for a healthier world. Retrieved from Net Solutions: https://www.netsolutions.com/insights/5-healthcare-problems-which-digital-technologies-can-solve-for-a-fit-and-healthy-world/

DeSanctis, G., & Poole, M. S. (1994). Capturing the complexity in advanced technology use: Adaptive Structuration Theory. Organization Science, 5(2), 121–147.

Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: Literature review. JMIR Med Inform, 6(2).

Halamka, J., Mandl, K., & Tang, P. (2008). Early experiences with personal health records. Journal of the American Medical Informatics Association, 15(1), 1–7.

IOM. (1999). To err is human: Building a safer health system. National Academy of Sciences.

Singh, H., & Sittig, D. (2016). Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Quality & Safety, 25, 226–232.

Weigel, F., Hall, D. J., & Landrum, W. H. (2009). Human/technology adaptation fit theory for healthcare. SAIS 2009 Proceedings.