Kaija Saranto

Methods for Addressing Technology-induced Errors: The Current State

OBJECTIVES The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. METHODS The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. RESULTS The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. CONCLUSIONS Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-induced errors. Although there remain issues and challenges associated with the methodologies, they have been shown to improve the quality and safety of HIT. Since the first publications documenting technology-induced errors in healthcare in 2005, we have seen in a short 10 years researchers develop ways of identifying and addressing these types of errors. We have also seen organizations begin to use these approaches. Knowledge has been translated into practice in a short ten years whereas the norm for other research areas is of 20 years.

Patient-Centred Coordinated Care in Times of Emerging Diseases and Epidemics

OBJECTIVES In this paper the researchers describe how existing health information technologies (HIT) can be repurposed and new technologies can be innovated to provide patient-centered care to individuals affected by new and emerging diseases. METHODS The researchers conducted a focused review of the published literature describing how HIT can be used to support safe, patient-centred, coordinated care to patients who are affected by Ebola (an emerging disease). RESULTS New and emerging diseases present opportunities for repurposing existing technologies and for stimulating the development of new HIT innovation. Innovative technologies may be developed such as new software used for tracking patients during new or emerging disease outbreaks or by repurposing and extending existing technologies so they can be used to support patients, families and health professionals who may have been exposed to a disease. The paper describes the development of new technologies and the repurposing and extension of existing ones (such as electronic health records) using the most recent outbreak of Ebola as an example.

eHealth and health informatics competences: A systemic analysis of literature production based on bibliometrics

The rapid development of eHealth requires the extension of existing health informatics competences sets. These competences are needed not only by health-care professionals but also by health-care consumers. The purpose of this paper is to analyse literature production of health informatics and eHealth competences/skills (EHCS).,Bibliometric analysis and mapping have been used as a form of distant reading approach in the manner to perform thematic analysis, identify gaps in knowledge and predict future trends.,This study shows that the literature production of health informatics and EHCS differs in bibliometric indicators, as well as in research content. Thematic analysis showed that medicine is the most productive subject area in both fields. However, health informatics competencies/skills are more oriented toward education, nursing, electronic health record and evidence-based practice, while EHCS cover health information technology, engineering, computer science and patient-centred care. The literature research production exhibits positive trend and is geographically widespread in both fields.,The use of Scopus database might have led to different results if the authors had used Web of Science or Medline, because of the fact that different databases cover different lists of source titles. The authors used various search strings, and the most optimal one for their study; however, a different search string might result in slightly different outcomes. In addition, the thematic analysis has been performed on information source abstracts and titles only, as the analysis of full texts (if available) could lead to different results. Despite the fact that the thematic analysis has been performed by three researchers with different scientific backgrounds, the results of the analysis are subjective. On the other hand, the bibliometric analyses and comparison of health informatics and eHealth competences have never been done before and this study revealed some important gaps in research in both fields.,The World Health Organization defined four distinct but related components of eHealth: mobile health, health information systems, telemedicine and distance learning. While the research in telemedicine and health information systems seems to be well covered, the skills and competencies in mobile health and distant learning should be researched more extensively.,More research in the skills and competencies associated with so-called connected health, a new subfield in eHealth research, is needed. The skills and competencies of how to better implement and use the services related to the management of chronic diseases, health coproduction and how to implement eHealth in developing countries are currently under research areas and with candidates for future research. For both health informatics competencies/skills and EHCS, we noted that more research is needed for personalised medicine, health coproduction, smart health, internet of things, internet of services and intelligent health systems.,The literature production on health informatics and EHCS has been analysed for the first time and been compared in a systemic way, using bibliometrics. The results reveal that current research directions as well as knowledge gaps could thus provide guidelines for further research.

Tietorakenteet potilaan hoitotietojen kirjaamisessa – Case hoitotyön yhteenveto

The aim of this study was to evaluate how the data structure of a national nursing discharge summary and the contents of nursing records of a transferring patient were followed within nursing discharge summaries. In this study, we described the overlapping data structures of nursing discharge summaries that had been compiled by both nurses and doctors. In addition, we described what other data structures were used. The data (N=87) were collected from the electronic patient record system in electronic format from nine inpatient wards of the research organization. The data were analyzed by calculating the frequencies and percentages of the use of data structures. The link between the different headings of the data was tested with the chi-square test and the odds rations were calculated to describe the strength of association between headings. According to the results, although the national data structure of the nursing discharge summary was used well, its use was not systematic within the same summary, and regional content titles were only partially used. Overlapping data structures were used in both nursing discharge summaries and medical summaries. Non-structured designs, which do not belong to the national structure, were also used. Therefore, health care electronic data structures must be further developed to ensure uniform completion per the determined data structure. In addition, health care professionals must be thoroughly trained to use the determined data structures; patients require uniform summaries that contain clear and usable information to support their own treatment.

Tiedonhallinnan prosessimallin hyödyntäminen sosiaali- ja terveydenhuollon tiedonhallintaa koskevissa tutkimuksissa

Scientific research is based on a selected theory or a theoretical model which also will serve a basis for reviewing the results. Information management cycle has been used as a theoretical model in social and health care studies, but gathered information on the usability of the model in social and health care research has been lacking. The aim of this study is to reduce this lack of information. A descriptive literature review was used and in total 16 social and health care studies were selected for the study. Information management cycle was used to review the results and to develop new information management models. The studies were mainly qualitative and informants mainly social and health care professionals. Information from data warehouses was used only in three studies. Studies results were reviewed according to information management cycle. The use of information was mainly reviewed in the studies were results were reviewed according to every phase of the information management cycle or in which also information needs and/or information acquisition were reviewed. This study showed that information management cycle is well applicable in social and health care studies. This study also showed that social- and health care information management research needs more quantitative and register research. This article reviewed studies, dissertations and master’s theses which had been carried out in social and health care context and in which information management cycle was used.

Integrating Health Information Technology Safety into Nursing Informatics Competencies

Nursing informatics competencies are constantly changing in response to advances in the health information technology (HIT) industry and research emerging from the fields of nursing and health informatics. In this paper we build off the work of Staggers and colleagues in defining nursing informatics competencies at five levels: the beginning nurse, the experienced nurse, the nursing informatics specialist, the nursing informatics innovator and the nursing informatics researcher in the area of HIT safety. The work represents a significant contribution to the literature in the area of nursing informatics competency development as it extends nursing informatics competencies to include those focused on the area of technology-induced errors and HIT safety.

The Impact of Information Culture on Patient Safety Outcomes

Summary Background An organization’s information culture and information management practices create conditions for processing patient information in hospitals. Information management incidents are failures that could lead to adverse events for the patient if they are not detected. Objectives To test a theoretical model that links information culture in acute care hospitals to information management incidents and patient safety outcomes. Methods Reason’s model for the stages of development of organizational accidents was applied. Study data were collected from a cross-sectional survey of 909 RNs who work in medical or surgical units at 32 acute care hospitals in Finland. Structural equation modeling was used to assess how well the hypothesized model fit the study data. Results Fit indices indicated a good fit for the model. In total, 18 of the 32 paths tested were statistically significant. Documentation errors had the strongest total effect on patient safety outcomes. Organizational guidance positively affected information availability and utilization of electronic patient records, whereas the latter had the strongest total effect on the reduction of information delays. Conclusions Patient safety outcomes are associated with information management incidents and information culture. Further, the dimensions of the information culture create work conditions that generate errors in hospitals.