Using automated methods to detect safety problems with health information technology: a scoping review

Health information technology (HIT) can play an important role in supporting care delivery and improving patient safety.1–6 Problems with HIT however can introduce new, often unforeseen,7 modes of failure that reduce the safety and quality of clinical care and may lead to patient harm and death.8 Risks to patients can arise from problems with HIT design or manufacture, the way they are implemented, or how they are used.9 Unlike most other risks to patient safety, HIT problems can—because of their scale and scope—harm many patients in a single event.10,11 Current approaches to detecting HIT problems are primarily based on clinicians’ reports, which often appear well after the fact and so are not directly actionable.8,12 Many HIT problems are thus either undetected or are detected after patients have been harmed.13

One approach to minimize the impact of HIT problems is to proactively monitor clinical data to detect risks in real-time before care is disrupted or patients are harmed. Traditional methods for IT system surveillance are focused on the IT infrastructure and software applications (Figure 1), and have limited ability to detect complex problems that emerge from interactions among separate software and hardware components.14 Yet it is these interactional failures that characterize HIT system problems, which often comprise multiple software and hardware components. Monitoring at the data level can overcome these limitations. By prospectively monitoring at the clinical data level, HIT problems can be detected early before they become more widespread, thus minimizing disruption to care delivery and risks to patients.15,16

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