An analysis of computer-related patient safety incidents to inform the development of a classification
Open accessAbstract
OBJECTIVE: To analyze patient safety incidents associated with computer use to develop the basis for a classification of problems reported by health professionals. DESIGN: Incidents submitted to a voluntary incident reporting database across one Australian state were retrieved and a subset (25%) was analyzed to identify 'natural categories' for classification. Two coders independently classified the remaining incidents into one or more categories. Free text descriptions were analyzed to identify contributing factors. Where available medical specialty, time of day and consequences were examined. MEASUREMENTS: Descriptive statistics; inter-rater reliability. RESULTS: A search of 42,616 incidents from 2003 to 2005 yielded 123 computer related incidents. After removing duplicate and unrelated incidents, 99 incidents describing 117 problems remained. A classification with 32 types of computer use problems was developed. Problems were grouped into information input (31%), transfer (20%), output (20%) and general technical (24%). Overall, 55% of problems were machine related and 45% were attributed to human-computer interaction. Delays in initiating and completing clinical tasks were a major consequence of machine related problems (70%) whereas rework was a major consequence of human-computer interaction problems (78%). While 38% (n=26) of the incidents were reported to have a noticeable consequence but no harm, 34% (n=23) had no noticeable consequence. CONCLUSION: Only 0.2% of all incidents reported were computer related. Further work is required to expand our classification using incident reports and other sources of information about healthcare IT problems. Evidence based user interface design must focus on the safe entry and retrieval of clinical information and support users in detecting and correcting errors and malfunctions.
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Claims the paper makes
0 of 34 cited sources checked · 0 supported · 0 flagged
- Findingown data
A search of 42,616 incidents reported between 2003 and 2005 yielded 123 computer-related incidents.
“A search of 42 616 incidents from 2003 to 2005 yielded 123 computer related incidents.”
- Also stated in: § RESULTS · plain
“Our search strategy retrieved 123 incidents, 23 of which were retrieved using AIMS and the remainder from free-text searches of incident descriptions (see online supplementary appendix B, available at www.jamia.org).”
Quote in the paperSubstantial claim- Rests on an assumption: The keyword-based free-text search strategy comprehensively identifies computer-related patient safety incidents in the AIMS database.
- Also stated in: § RESULTS · plain
- Findingown data
A classification with 32 types of computer use problems was developed.
“A classification with 32 types of computer use problems was developed.”
Quote in the paperSubstantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
After removing duplicates and unrelated incidents, 99 incidents describing 117 problems remained.
“After removing duplicate and unrelated incidents, 99 incidents describing 117 problems remained.”
- Also stated in: § Classification of computer-related problems · plain
“Examination of the remaining 99 incidents revealed 117 problems.”
Quote in the paperSubstantial claim- Rests on an assumption: The keyword-based free-text search strategy comprehensively identifies computer-related patient safety incidents in the AIMS database.
- Also stated in: § Classification of computer-related problems · plain
- Findingown data
Rework was a major consequence of human-computer interaction problems (78%).
“rework was a major consequence of humancomputer interaction problems (78%)”
- Also stated in: § Classification of computer-related problems · plain
“In contrast, rework was a major consequence of problems in humanecomputer interaction (78%, n¼18).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Also stated in: § Classification of computer-related problems · plain
- Findingown data
Delays in initiating and completing clinical tasks were a major consequence of machine-related problems (70%).
“Delays in initiating and completing clinical tasks were a major consequence of machine related problems (70%)”
- Also stated in: § Classification of computer-related problems · plain
“Delays in initiating and completing clinical tasks directly related to patient care were a major consequence of machine-related problems (70%, n¼39).”
Quote in the paperSubstantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Also stated in: § Classification of computer-related problems · plain
- Findingnone given
Only 0.2% of all incidents reported were computer related.
“Only 0.2% of all incidents reported were computer related.”
- Also stated in: § CONCLUSION · plain
“Only 0.2% of all incidents reported were computer related.”
Quote in the paperSubstantial claim- Rests on an assumption: The keyword-based free-text search strategy comprehensively identifies computer-related patient safety incidents in the AIMS database.
- Also stated in: § CONCLUSION · plain
- Findingown data
Problems were grouped into information input (31%), transfer (20%), output (20%) and general technical (24%).
“Problems were grouped into information input (31%), transfer (20%), output (20%) and general technical (24%).”
Quote in the paperSubstantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
General technical problems accounted for 24% of the incidents (n=28).
“General technical problems accounted for 24% of the incidents (n¼28).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Use of hybrid paper-electronic systems sometimes resulted in omission errors where clinicians were not notified about results.
“Use of hybrid papereelectronic systems sometimes resulted in omission errors where clinicians were not notified about results (eg, 'doctor/hospital team not notified about abnormal results from private abdominal ultrasound scan available on computer system, results available online but not sent to doctor as requested').”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Failed output devices prevented access to results.
“Failed output devices prevented access to results.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Problems in human-computer interaction (n=10, 8.5%) included errors in the interpretation of printed and online information due to poor quality or misleading presentation.
“Problems in humanecomputer interaction (n¼10, 8.5%) included errors in the interpretation of printed and online information due to poor quality or misleading presentation.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
The vast majority of computer-related incidents, although often delaying clinical work and creating rework, did not directly harm patients.
“The vast majority of computer-related incidents, although often delaying clinical work and creating rework, did not directly harm patients.”
Quote in the paperSubstantial claim - Findingown data
A number of human factors (n=7, 6.0%) were reported to directly lead to patient safety incidents.
“A number of human factors (n¼7, 6.0%) were reported to directly lead to patient safety incidents.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Workarounds and re-organization were the most common strategies to cope with general technical problems which prevented access to patient and clinical information.
“Workarounds and re-organization were the most common strategies to cope with general technical problems which prevented access to patient and clinical information (eg, 'staff required to compile manual lists resulting in delays', 'doctors must leave the ED to view x-rays', 'clinicians making decisions without radiology results', 'major trauma redirected to another hospital').”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Transfer incidents were sometimes associated with routine maintenance activities, making systems inaccessible from 15 min to 8 h.
“While the occurrence of these incidents was generally unpredictable, they were sometimes associated with routine maintenance activities (eg, planned server upgrade) making a range of systems (eg, CPOE, electronic medical records (EMR), Imaging) inaccessible from as little as 15 min to as long as 8 h.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Specific contributing factors were cited for only 6% of problems.
“Specific contributing factors were cited for only 6% of problems.”
Quote in the paperSubstantial claim - Findingown data
Information input problems were the largest category, accounting for 31% of incidents (n=36).
“Information input problems were the largest category, accounting for 31% of incidents (n¼36).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingcitation
In contrast to the MEDMARX data, a larger proportion of incidents related to computer system failures was found (2.8% MEDMARX vs 9.4%).
“In contrast to the MEDMARX data, we found a larger proportion of incidents related to computer system failures (2.8% MEDMARX vs 9.4%).17”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] source
Not checked in the free run.
- Findingown data
Systems integration problems (n=11, 9.4%) were reported to be the primary cause for incomplete and lost requests sent to pathology and radiology departments and for missing results.
“Systems integration problems (n¼11, 9.4%) were reported to be the primary cause for incomplete and lost requests sent to pathology and radiology departments and for missing results.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Self-detection and correction of mistakes was not supported by the existing technology.
“However, self-detection and correction of mistakes was not supported by the existing technology, for example staff could not easily cancel a request and needed to contact the intended recipient by telephone or face-to-face to intercept incorrect pathology or radiology orders.”
Quote in the paperSubstantial claim - Findingown data
Rework was associated with 78% of problems in human-computer interaction.
“Rework was associated with 78% of problems in humanecomputer interaction (table 2).”
Quote in the paperNot a substantial claim - Findingown data
Problems in the transfer of information accounted for 20% of all incidents.
“Problems in the transfer of information accounted for 20% of all incidents.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Twelve incidents in the dataset were associated with an adverse event or a near miss, with actual or potential patient harm.
“Twelve incidents in our dataset were associated with an adverse event or a near miss (see online supplementary appendix C), with actual or potential patient harm.”
Quote in the paperNot a substantial claim - Findingown data
Most input problems were associated with incorrect human data entry (17%, n=20).
“Most were associated with incorrect human data entry (17%, n¼20), such as incorrect selection of patient name, diagnosis, diet codes, discharge hospital, and typographical errors.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Input errors also resulted from entry into incorrect fields.
“Input errors also resulted from entry into incorrect fields.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Only 99 patient safety incidents out of 42,616 (0.2%) were related to IT.
“We found only 99 patient safety incidents out of 42 616 (0.2%) that were related to IT.”
Quote in the paperSubstantial claim - Findingreasoning
A separate communication channel was useful in tracing missing pathology or radiology requests.
“A separate communication channel was also useful in tracing missing pathology or radiology requests.”
Quote in the paperNot a substantial claim - Findingown data
Transfer problems were almost evenly attributed to computer network and systems integration issues.
“These were almost evenly attributed to computer network and systems integration issues.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Multitasking was reported to be a contributing factor in one high-risk (SAC 2) incident in which a wrong blood test request form was picked up from a printer out-tray.
“Multitasking was reported to be a contributing factor in one high-risk (SAC 2) incident in which a wrong blood test request form was picked up from a printer out-tray.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingnone given
The redundancy provided by a dual system was sometimes reported to be useful in verifying and correcting irregularities.
“On the other hand, the redundancy provided by a dual system was sometimes reported to be useful in verifying and correcting irregularities.”
Quote in the paperNot a substantial claim - Findingown data
Equipment problems accounted for only two of the input incidents.
“Equipment problems accounted for only two of these incidents.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Ongoing staff vigilance was highly effective in preventing incidents from turning into adverse events.
“Ongoing vigilance (staff detecting mistakes) was highly effective in preventing incidents from turning into adverse events (with harm to patients).”
Quote in the paperSubstantial claim - Findingown data
A transfusion computer program that cross-checked records at multiple sites identified an ABO blood group discrepancy.
“In one case a discrepancy in the ABO blood group was identified by a transfusion computer program that was used to cross-check records maintained at multiple sites.”
Quote in the paperNot a substantial claim - Findingnone given
The consequences of IT problems, including delays and rework, were similar to previous analyses.
“The consequences of IT problems, including delays and rework, were also similar.”
Quote in the paperNot a substantial claim - Findingown data
The presence of a hybrid electronic-paper system meant that not all staff were trained to access the computer system.
“The presence of a hybrid electronicepaper system meant that not all staff were trained to access the computer system (eg, 'ward clerk not available to access EMR').”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Some specific effects such as dispatch of medications to the wrong room were common.
“Some specific effects such as dispatch of medications to the wrong room, were also common.”
Quote in the paperNot a substantial claim - Findingown data
Data retrieval errors were another type of output problem.
“Data retrieval errors were another type of output problem (eg, receptionist relied on date-of-birth search to identify records with similar sounding names).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Findingown data
Consistent with previous analyses of IT incidents involving medications, a range of human-computer interaction errors related to selection of patient and clinical information, and display errors were found.
“Consistent with previous analyses of IT incidents involving medications, we found a range of humanecomputer interaction errors related to selection of patient and clinical information, and display errors.”
Quote in the paperNot a substantial claim - Findingcitation
Other well-known problems previously identified in the literature, such as failure to update rules for decision support systems, are not represented in the dataset.
“For instance, other well-known problems previously identified in the literature, for example failure to update rules for decision support systems, 38 are not represented here.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [38] source
Not checked in the free run.
- Premisecitation
Available data suggest that healthcare IT can pose a significant risk to patient safety.
“Although evidence about the risks associated with healthcare IT is scarce, the available data suggest that it can pose a significant risk to patient safety.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [6] US Office of the National Coordinator for Health IT, HIT Policy Committee, Adoption/Certification Workgroup meeting 2010. http://healthit.hhs.gov/.
Not checked in the free run.
- Premisecitation
Existing classifications, including AIMS and the ICPS, fall short with respect to computer-related incidents because this source of risk has not been systematically examined.
“However, existing classifications, including AIMS and the ICPS, 18 fall short with respect to computer-related incidents as this source of risk has yet to be systematically examined.20”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationcitation
The low citation of contributing factors reflects the manner in which the reporting system was used.
“This reflects the manner in which the reporting system was used, and has been the subject of comment elsewhere.35”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [35] Schultz T Hannaford N Runciman B . Improving learning from patient safety incidents: patient identification and clinical handover. Final report prepared for the Australian Commission on Safety and Quality in Health Care. Adeliade: Australian Patient Safety Foundation, 2009.
Not checked in the free run.
- Premisecitation
Computer-related incidents account for about 60% of incident-related resource consumption.
“Nevertheless, they account for about 60% of incident-related resource consumption.30”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] source
Not checked in the free run.
- Premisecitation
Multi-tasking and interruptions are ubiquitous in clinical work.
“Observer studies have confirmed that multi-tasking and interruptions are ubiquitous in clinical work.36”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36] Westbrook JI Woods A . Development and testing of an observational method for detecting medication administration errors using information technology. Stud Health Technol Inform 2009;146:429–33.
Not checked in the free run.
- Study design and conductown data
Inter-rater reliability was k=0.71 (p<0.001), 95% CI 0.06 to 0.80.
“Inter-rater reliability was k¼0.71 (p<0.001),95% CI 0.06 to 0.80.32”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [32] source
Not checked in the free run.
- Interpretationnone given
Work processes where staff must update two sets of records may introduce new opportunities for error.
“While dual paper and electronic systems may be unavoidable initially, work processes where staff must update two sets of records may introduce new opportunities for error.”
Quote in the paperNot a substantial claim - Interpretationcitation
Building on previous approaches, the authors' categorization expands the two high-level categories of human-computer and machine-related problems identified by others.
“Building on previous approaches to examining healthcare IT incidents, our categorization expands the two high-level categories of humanecomputer and machine-related problems identified by others. 1 8”
Quote in the paperSubstantial claim0 of 2 sources checked - Premisecitation
Incident reports provided by healthcare professionals have been shown to be useful in examining the risks and harm caused by healthcare.
“Incident reports provided by healthcare professionals have been shown to be useful in examining the risks and harm caused by healthcare (eg, falls, medication errors, therapeutic devices, and equipment).18 19”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationown data
The negative impact of computer-related incidents on patient safety is small but noticeable.
“Overall, the negative impact of computer-related incidents on patient safety is small but noticeable.”
Quote in the paperSubstantial claim - Interpretationreasoning
A factor in the low rate of reporting is that multi-tasking and interruptions are generally accepted by staff as an inevitable part of clinical work and may not be recognized or reported as explicit contributing factors.
“A factor in the low rate of reporting is that multi-tasking and interruptions seem generally accepted by staff as an inevitable part of clinical work and may not be recognized or reported as explicit contributing factors.”
Quote in the paperNot a substantial claim - Study design and conductown data
The nature of the study does not allow determination of which problems would also have occurred with paper records.
“The nature of our study does not allow us to determine which of these problems would also have occurred with paper records.”
Quote in the paperNot a substantial claim - Premisecitation
Changes in the profile of what goes wrong over time can suggest the elimination of some old problems and the emergence of some new ones.
“Although no cause and effect relationships can be reported with confidence, changes in the profile of what goes wrong over time can suggest the elimination of some old problems and the emergence of some new ones.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37] Runciman WB . Iatrogenic harm and anaesthesia in Australia. Anaesth Intensive Care 2005;33:297–300. source
Not checked in the free run.
- Interpretationnone given
Voluntary incident reports are useful, as in other spheres of activity, in identifying the nature and consequences of some of the problems of using IT in routine clinical settings.
“Voluntary incident reports are useful, as in other spheres of activity, in identifying the nature and consequences of some of the problems of using IT in routine clinical settings.”
Quote in the paperSubstantial claim- Rests on an assumption: Incident reports are useful for learning even when no actual harm resulted, when clinicians feel that there has been a near miss or that a catastrophic outcome could have resulted.
- May combine two claims. 29
- Classified as probably not a substantial claim. 15
May combine two claims.
Findingown dataOverall, 55% of problems were machine related and 45% were attributed to human-computer interaction.
“Overall, 55% of problems were machine related and 45% were attributed to human-computer interaction.”
- Also stated in: § Classification of computer-related problems · plain
“Of these, 55% (n¼64) were machine-related problems and 45% (n¼53) were problems in humanecomputer interaction (table 2).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Also stated in: § Classification of computer-related problems · plain
May combine two claims.
Findingown dataOf the incidents, 38% (n=26) had a noticeable consequence but no harm, while 34% (n=23) had no noticeable consequence.
“While 38% (n¼26) of the incidents were reported to have a noticeable consequence but no harm, 34% (n¼23) had no noticeable consequence.”
- Also stated in: § RESULTS · plain
“While 38% (n¼26) of the incidents were reported to have a noticeable consequence but no harm, 34% (n¼23) had no noticeable consequence.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
- Also stated in: § RESULTS · plain
May combine two claims.
Findingown dataInformation output problems accounted for 20% of incidents (n=23) caused by malfunctioning peripheral devices (n=13, 11%).
“Information output problems accounted for 20% of incidents (n¼23) caused by malfunctioning peripheral devices (n¼13, 11%; eg, printers and monitors).”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataSome incidents (6.0%, n=7) related to problems in updating data and missing data (6.0%, n=7).
“Some incidents (6.0%, n¼7) related to problems in updating data (eg, 'computer system not updated when patient transferred between wards', 'medication lists not updated on admission') and missing data (6.0%,n¼7) (eg, 'details of primary care physician not entered in online system').”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataSoftware-related errors were detected by vigilant staff and required rework to correct mistakes.
“Softwarerelated errors were detected by vigilant staff and required rework to correct mistakes (eg, 'letters needed to be re-done').”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataIn eight incidents, IT improved patient safety by helping detect drug-drug interactions, duplicate medication orders, MRSA infection risk, checking and correcting dialysis treatment, finding discrepancies in antenatal paper records, and providing up-to-date contact details.
“Examination of these incidents (n¼8) revealed that the availability and sharing of electronic health records (EHR) aided detection of drugedrug interactions (eg, warfarine tramadol), duplicate medication orders and MRSA infection risk, assisted checking and correction of dialysis treatment, found discrepancies in antenatal paper records, and provided up-to-date contact details.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
Findingown dataThe authors expanded these categories to identify specific manifestations and added two general categories to account for technical problems and contributing factors described by reporters.
“We have expanded these categories to identify specific manifestations of these problems and added two general categories to account for technical problems and contributing factors described by reporters.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataPoor performance or failure of a single workstation prevented staff from carrying out tasks, caused delays, and was reported to be a source of significant frustration.
“As with network problems, poor performance or failure of a single workstation prevented staff from carrying out tasks (eg, 'nurses unable to access results and complete handovers', 'clinician unable to access care plan for frequently presenting patient who required treatment within 30 min in Emergency'), caused delays and were reported to be a source of significant frustration.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataNotification problems delayed treatment and were reported to be a source of frustration for staff who needed to act upon test results.
“Notification problems delayed treatment and were reported to be a source of frustration for staff who needed to act upon test results.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataPotential and actual breaches of patient privacy were reported to be the consequence of printouts left at patients' bedsides as well as failure to log-off the computer system.
“Potential and actual breaches of patient privacy were reported to be the consequence of printouts left at patients' bedsides as well as failure to log-off the computer system.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
FindingreasoningLack of access to the computer system often resulted in workarounds relying on paper-based records, which were often inefficient and ineffective.
“Lack of access to the computer system (eg, EHR) often resulted in workarounds relying on paper-based records, which were often inefficient and ineffective.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataTechnical issues relating to computer hardware, software, or networking infrastructure accounted for over half the problems reported (55%), with human factors reported to be the primary cause in the remaining 45%.
“We found that technical issues relating to computer hardware, software, or networking infrastructure accounted for over half the problems reported (55%), with human factors reported to be the primary cause in the remaining 45%.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataOf the 111 incidents, eight described an improvement in patient safety due to IT, and four were unresolvable.
“Of the 111 incidents, eight described an improvement in patient safety due to IT, and four were unresolvable.”
Quote in the paperNot a substantial claim- Rests on an assumption: The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
May combine two claims.
Findingown dataReported contributing factors included lack of training, failure to carry out a duty, high cognitive workload, and the effects of multitasking.
“Factors reported including the lack of training, failure to carry out a duty, high cognitive workload, and the effects of multitasking.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDelays in initiating or completing clinical tasks were a major consequence of the computer-related incidents examined, and were associated with 70% of machine-related problems.
“Delays in initiating or completing clinical tasks were reported to be a major consequence of the computer-related incidents we examined, and were associated with 70% of machine-related problems.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataSix out of 10 problems in human-computer interaction related to data entry (64%), and retrieval of clinical and patient data was also problematic.
“Six out of 10 problems in humane computer interaction related to data entry (64%), and retrieval of clinical and patient data was also problematic.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataMachine-related problems (software- and hardware-related) accounted for more than half of the problems, with most of the remainder attributed to problems with human-computer interactions.
“Machine-related problems (software-and hardware-related) accounted for more than half of the problems, with most of the remainder attributed to problems with humanecomputer interactions.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingcitationFewer mismatches between actual clinical workflow and the system model were reported compared to Koppel et al's mixed method study, most likely representing a narrower focus on the part of clinicians forwarding incidents.
“Fewer mismatches between actual clinical workflow and the system model were reported in comparison to Koppel et al's mixed method study, most likely representing a narrower focus on the part of clinicians forwarding incidents.8”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [8] source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationPatient safety risks and incidents caused by problems with computer use are widely recognized as an unintended consequence of healthcare information technology.
“Patient safety risks and incidents caused by problems with the use of computers are now widely recognized as an unintended consequence of healthcare information technology (IT), 1e3 just as 'revenge effects' have been described after other system changes.4”
Quote in the paperSubstantial claim0 of 2 sources checked- cites 1e3
Not checked in the free run.
- cites [4] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIn February 2010, the US FDA reported receiving information on 260 incidents with potential for patient harm, including 44 injuries and six deaths.
“In February 2010, the US Food and Drug Administration (FDA) reported receiving information on 260 incidents with potential for patient harm including 44 injuries and six deaths.6”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [6] US Office of the National Coordinator for Health IT, HIT Policy Committee, Adoption/Certification Workgroup meeting 2010. http://healthit.hhs.gov/.
Not checked in the free run.
May combine two claims.
PremisecitationWith large collections of incidents, characteristic profiles may be identified, allowing incidents to be aggregated and analyzed.
“However, with large collections of incidents, characteristic profiles may be identified, allowing incidents to be aggregated and analyzed.23”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Symposium. The Australian Incident Monitoring System. Anaesth Intensive Care 1993;21:501–695. source
Not checked in the free run.
May combine two claims.
PremisecitationIncident reports do not yield true frequencies of errors or adverse events because they do not capture numerators or denominators, and are subject to bias from a number of sources.
“It is important to note that incident reports do not yield true frequencies of errors or adverse events because they do not capture numerators or denominators, and are subject to bias from a number of sources.22”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
May combine two claims.
PremisecitationThe ICPS framework is based upon existing classifications such as AIMS, with additional input from international experts in safety, systems engineering, health policy, medicine, and the law.
“The framework is based upon existing classifications such as AIMS, with additional input from international experts in safety, systems engineering, health policy, medicine, and the law.5 28 29”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
PremisecitationTwo of the main categories map to the high-level error classes first identified by Ash et al.: 'Information input problems' and 'information output problems' correspond to errors in 'entering and retrieving information', and 'information transfer problems' correspond to 'communication and co-ordination'.
“Two of our main categories map to the high-level error classes first identified by Ash et al. 1 'Information input problems' and 'information output problems' correspond to errors in 'entering and retrieving information', and 'information transfer problems' correspond to 'communication and co-ordination'.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIdentifying the natural categories of safety incidents has been the method used for creating the AIMS classification, which is the starting point for expanding the ICPS.
“Identifying the natural categories of safety incidents has been the method used for creating the AIMS classification, which is the starting point for expanding the ICPS.18 30”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenWhen coders disagreed on a primary classification, the event was re-examined and a consensus category assigned.
“When coders disagreed on a primary classification, the event was re-examined and a consensus category assigned.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone givenSuch a classification will allow information about computer-related incidents to be collated and classified, providing an objective basis for comparing patterns over time and between settings, and for the development and prioritization of preventive and corrective strategies.
“Such a classification will allow information about computer-related incidents to be collated and classified, providing an objective basis for comparing patterns over time and between settings, and for the development and prioritization of preventive and corrective strategies.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIncident reporting to facilitate rapid communication of safety flaws and critical events arising from computer use is one of seven steps proposed to improve the safety of healthcare IT.
“Indeed, incident reporting to facilitate rapid communication of safety flaws and critical events arising from computer use is one of seven steps which have been proposed to improve the safety of healthcare IT. 20”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [20] source
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductreasoningThe classification was developed without reference to AIMS to avoid constraining the range of new categories.
“This was done without reference to AIMS to avoid constraining the range of new categories.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationSittig and Classen endorse the reporting of computer-related incidents as an essential component of their framework for safe use of IT systems.
“Sittig and Classen 21 endorse the reporting of computer-related incidents as an essential component of their framework for safe use of IT systems.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationComputers are listed as an option under the 'medical equipment/device' category within an equipment list sourced from the ECRI's Universal Medical Device Nomenclature System (UMDNS).
“Computers are listed as an option under the 'medical equipment/device' category within an equipment list that is sourced from the ECRI's Universal Medical Device Nomenclature System (UMDNS).26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Emergency Care Research Institute (ECRI) [Internet] 2010. http://www.ecri.org (accessed Nov 2008).
Not checked in the free run.
May combine two claims.
Interpretationown dataThe AIMS system does not specifically elicit information about IT incidents, which may have inhibited reporting.
“the system used (AIMS) does not specifically elicit information about IT incidents, which may have inhibited reporting (most incidents in our analysis were retrieved from free-text descriptions)”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe classification developed for AIMS allows incidents to be grouped according to 13 healthcare incident types (HIT).
“The classification developed for AIMS allows incidents to be grouped according to 13 healthcare incident types (HIT), such as 'clinical process/procedure' or 'medication/ IV fluid.' 23e25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites 23e25
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe Advanced Incident Management System (AIMS) is an incident reporting system based on 20 years of patient safety research, in use since 1998 in more than 1000 facilities across Australia, New Zealand, South Africa, and the United States.
“The Advanced Incident Management System (AIMS) 18 is one such incident reporting system, based on 20 years of research in patient safety, and has been in use since 1998 in more than 1000 facilities in Australia, New Zealand, South Africa, and the United States.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA framework for an International Classification for Patient Safety (ICPS) has been agreed to by a drafting group convened by the WHO World Alliance for Patient Safety.
“Recently, a framework for an International Classification for Patient Safety (ICPS) has been agreed to, by a drafting group convened by the World Health Organization (WHO) World Alliance for Patient Safety.27”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] International Classification for Patient Safety [Internet] 2010. http://www.who.int/patientsafety/en/ (accessed Feb 2010).
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe dataset used, from one Australian state, has limitations imposed by the education provided and practices which evolved in that state with respect to incident reporting.
“Another limitation is that the dataset used, from one Australian state, has limitations imposed by the education provided and practices which evolved in that state with respect to incident reporting.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationThe incidents studied are based on self-reports provided to a voluntary incident reporting system, with inherent limitations such as a bias toward reporting incidents which appear interesting or unusual.
“The incidents studied here are based on self-reports provided to a voluntary incident reporting system, with all the inherent limitations of such a system, such as a bias toward reporting incidents which appear interesting or unusual.22”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
May combine two claims.
PremisecitationIncident reports are useful in providing a profile of the nature of the problems encountered, and this profile has generally been shown to be consistent until interventions are introduced.
“As we have shown in other domains, such incident reports are useful in providing a profile of the nature of the problems encountered, and this profile has generally been shown to be consistent until interventions are introduced to address problems identified.22”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
May combine two claims.
Study design and conductown dataThe computer-related problems identified are limited to the types of IT systems in use at the time and represent only a small proportion of the kinds of problems that might be encountered.
“The computer-related problems we have identified are limited to the types of IT systems in use at the time and represent only a small proportion of the kinds of problems that might be encountered.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe incidents analyzed were reported over a significant period, providing sufficient data for some quantitative and qualitative analyses.
“However, the incidents analyzed were reported over a significant period, providing sufficient data for some quantitative and qualitative analyses.”
Quote in the paperSubstantial claim
The paper relies on this without support.
The keyword-based free-text search strategy comprehensively identifies computer-related patient safety incidents in the AIMS database.
“Free-text searches of incident description fields were conducted using a set of keywords generated by the investigators to describe computer hardware, software, or displays based upon knowledge of the clinical information systems deployed in the jurisdiction (box 1).”
The paper relies on this without support.
The 25% subset of incidents used to develop natural categories is representative of the full set of computer-related incidents.
“We examined the free-text descriptions of a quarter of the incidents retrieved (25% of 123) to identify 'natural categories' for classification.30”
The paper relies on this without support.
This is the first study to examine computer-related patient safety incidents reported by health professionals to a state-wide system to develop categories for a classification.
“This is the first study we are aware of which examines computer-related patient safety incidents reported by health professionals to a state-wide system in order to develop categories to provide the basis for a classification.”
The paper relies on this without support.
Patient safety incidents associated with computer use have not been extensively investigated.
“Patient safety incidents associated with computer use have not been extensively investigated.”
The paper relies on this without support.
The types of error are finite in number and, when systematically identified and addressed, can lead to improvements in patient safety.
“the types of error are finite in number and, when systematically identified and addressed, can lead to improvements in patient safety.”
The paper relies on this without support.
Incident reports are useful for learning even when no actual harm resulted, when clinicians feel that there has been a near miss or that a catastrophic outcome could have resulted.
“Incident reports are useful for learning even when no actual harm resulted, when clinicians feel that there has been a near miss or that a catastrophic outcome could have resulted.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A few studies have attempted to quantify and classify EHR-related safety concerns by mining patient safety incident reporting databases.
“A few studies have attempted to quantify and classify EHR-related safety concerns by mining patient safety incident reporting databases.18 29–31”
From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [30]
Previous studies have largely used isolated event reports without benefit of an independent human factors and informatics investigation to analyze safety concerns in the EHR.
“Previous studies have largely used isolated event reports without benefit of an independent human factors and informatics investigation to analyze safety concerns in the EHR.”
From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [30]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Koppel citation points to an Ash reference
MinorThe text cites reference 8 for work by Koppel and colleagues, but reference 8 lists Ash and colleagues; the Koppel entry is numbered 7.
“A similar categorization was used by Koppel et al 8 to describe the causes of 22 types of medication error specifically associated with computerized physician order entry (CPOE) systems at one US hospital.”
“8. Ash JS, Sittig DF, Dykstra R, et al. The unintended consequences of computerized provider order entry: findings from a mixed methods exploration. Int J Med Inform 2009;78(Suppl 1):S69e76.”
Software-unavailable row overstates its percentage
MinorTable 3 gives one software-unavailable problem among 117 problems. That is about 0.85%, which rounds to 1%, not 2%.
Reported 2 · recomputed 0.854701
“| 4.2 Software not available | 1 (2) | | |”
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“17 Differences in information models between systems means that semantic and technical interoperability always remains imperfect.”
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“missing results [54,64].”
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“15 20 We estimated that a mail-out to 2000 GPs would be sufficient, allowing for a response rate of 10% (participation rates in online incident reporting had been 26%, 15 and 40% for a mail survey 6 ).”
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“Recent literature has revealed several serious health information technology-related errors that arose from faulty system design, configuration, or implementation processes [98-101].”
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Real-Time Heart Pulse Monitoring Technique Using Wireless Sensor Network and Mobile Application
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“Today, wireless technology has been eliminated all of the time-consuming jobs as well; the patients could be independent of instrumentation and bed [11-13].”
BackgroundLyell, D., Wang, Y., Coiera, E. W., & Magrabi, F. (2023) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocad065 · Cited by 54 · see citing works
Self-citationSafety huddles to proactively identify and address electronic health record safety
Menon, S., Singh, H., Giardina, T. D., Rayburn, W. L., Davis, B. P., Russo, E. M., & Sittig, D. F. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw153 · Cited by 48 · see citing works
Wright, M. C., Borbolla, D. A., Waller, R. G., Fiol, G. D., Reese, T., Nesbitt, P., & Segall, N. (2019) · Journal of Biomedical Informatics · doi:10.1016/j.yjbinx.2019.100041 · Cited by 48 · see citing works
“However, the ability of information displays to support these activities has been criticized [3–5], and their use has been linked with errors that compromise patient safety [6,7].”
BackgroundMartin, G., Ghafur, S., Cingolani, I., Symons, J., King, D., Arora, S., & Darzi, A. W. (2019) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30057-3 · Cited by 49 · see citing works
Coiera, E. W., & Liu, S. (2022) · Cell Reports Medicine · doi:10.1016/j.xcrm.2022.100860 · Cited by 52 · see citing works
“Artificial intelligence safety It is now well understood that, along with many potential benefits, digital health can lead to patient harm if poorly designed, implemented, or used.(110) A review of the US FDA reports found 11% of IT-related incidents were associated with patient harm or death.”
BackgroundSelf-citationTechnology, cognition and error
Coiera, E. W. (2015) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003484 · Cited by 48 · see citing works
Self-citationHannaford, N., Mandel, C., Crock, C., Buckley, K. S., Magrabi, F., Ong, M., Allen, S., & Schultz, T. (2013) · British Journal of Radiology · doi:10.1259/bjr.20120336 · Cited by 49 · see citing works
Self-citationSafety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol
Singh, H., Ash, J. S., & Sittig, D. F. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-46 · Cited by 50 · see citing works
“The areas of expertise to be represented on the expert panel will include EHRs, patient safety, quality improvement, risk management, human factors engineering and usability, knowledge and experience with small physician office practices, and accreditation and certification practices for patient safety.”
BackgroundInfluentialMagrabi, F., Ong, M.-S., Runciman, W. B., & Coiera, E. W. (2011) · PubMed Central · Cited by 48 · see citing works
Self-citationEHR‐related medication errors in two ICUs
Carayon, P., Du, S., Brown, R., Cartmill, R. S., Johnson, M., & Wetterneck, T. B. (2017) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21259 · Cited by 43 · see citing works
The aspects of running artificial intelligence in emergency care; a scoping review
(2023) · Archives of Academic Emergency Medicine · doi:10.22037/aaem.v11i1.1974 · Cited by 45 · see citing works
Creating an Oversight Infrastructure for Electronic Health Record–Related Patient Safety Hazards
Singh, H., Classen, D. C., & Sittig, D. F. (2011) · Journal of Patient Safety · doi:10.1097/pts.0b013e31823d8df0 · Cited by 45 · see citing works
“DATA GATHERING OPERATIONS OF THE PROGRAM Voluntary reporting could continue to be an important source of data about EHR patient safety risks.(18) However, existing U.”
BackgroundRahman Jabin, M. S., & Pan, D. (2023) · DIGITAL HEALTH · doi:10.1177/20552076231203600 · Cited by 41 · see citing works
“Six incidents were identi fi ed under this theme (IR 2,5,6,17,18,22 ).”
BackgroundKushniruk, A. W., Nøhr, C. G., Takeda, H., Kuwata, S., Carvalho, C., Bainbridge, M., Kannry, J. L., & Borycki, E. M. (2013) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638828 · Cited by 42 · see citing works
“Unlike many other more traditional software errors (found during software testing such as white or black-box testing), technolo-gy-induced errors are often unobservable until systems are used under real-world conditions and/or in real-world settings (e.g. hospitals, clinics) [5, 14, 17].”
BackgroundJabin, M. S. R., Pan, D., & Nilsson, E. (2024) · Frontiers in Digital Health · doi:10.3389/fdgth.2024.1260521 · Cited by 41 · see citing works
Edwards, P., & Warm, D. (2012) · Applied Clinical Informatics · doi:10.4338/aci-2012-03-ra-0010 · Cited by 38 · see citing works
“The use of a framework such as that suggested by Magrabi et al [10, 11] is important in helping clinicians understand the types of incidents relating to the ever increasing use of health information technologies.”
MethodInfluentialUsability Flaws in Medication Alerting Systems: Impact on Usage and Work System
Ammenwerth, E., Roehrer, E., Sylvia Pelayo, A., Vasseur, F., Beuscart-Zéphir, M. C., & Marcilly, R. (2015) · Yearbook of Medical Informatics · doi:10.15265/iy-2015-006 · Cited by 36 · see citing works
“usability [6].”
Rahman Jabin, M. S., & Hammar, T. (2022) · DIGITAL HEALTH · doi:10.1177/20552076221131139 · Cited by 32 · see citing works
“36,42 Using the keywords, 24 electronic prescription-related incidents were identi fi ed (see Table 1), which were then subjected to an existing framework, i.e., the HIT-CS.”
InfluentialPan, D., Nilsson, E., & Rahman Jabin, M. S. (2024) · Health Informatics Journal · doi:10.1177/14604582241270742 · Cited by 32 · see citing works
Adams, K., Howe, J. L., Fong, A., Puthumana, J. S., Kellogg, K., Gaunt, M. J., & Ratwani, R. M. (2017) · Applied Clinical Informatics · doi:10.4338/aci-2017-01-ra-0014 · Cited by 32 · see citing works
“One study of patient safety hazards associated with computer use by healthcare providers reported that 20% of the safety hazard reports were associated with information transfer and about half of these were related to system integration problems [8].”
BackgroundWhat is the safety case for health IT? A study of assurance practices in England
Habli, I., White, S., Sujan, M. A., Harrison, S., & Ugarte, M. (2018) · Safety Science · doi:10.1016/j.ssci.2018.09.001 · Cited by 32 · see citing works
Fong, A., Adams, K. T., Gaunt, M. J., Howe, J. L., Kellogg, K. M., & Ratwani, R. (2018) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2018.09.007 · Cited by 32 · see citing works
Nohr, C., Jensen, S., Borycki, E. M., & Kushniruk, A. W. (2013) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638836 · Cited by 30 · see citing works
“Although many vendors of HIT now operate commercial usability laboratories where healthcare software systems products are designed and tested, reports of serious usability and safety issues continue to be reported globally [3-5,10].”
BackgroundInfluentialWang, J., Liang, H., Kang, H., & Gong, Y. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1678693 · Cited by 31 · see citing works
Borycki, E. M., Carayon, P., Jaspers, M., Sylvia Pelayo, A., & Beuscart-Zéphir, M.-C. (2013) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638835 · Cited by 30 · see citing works
“However recent research work on databases of patient safety incidents [27,28] demonstrated that: • The databases investigated do host reports of computer or HIT related incidents, but in very small proportion (0,1 % to 0,2%); this percentage is expected to grow in the future • A thorough secondary…”
BackgroundInfluentialA call for national e‐health clinical safety governance
Coiera, E. W., Kidd, M. R., & Haikerwal, M. C. (2012) · The Medical Journal of Australia · doi:10.5694/mja12.10475 · Cited by 28 · see citing works
Self-citationPatient safety goals for the proposed Federal Health Information Technology Safety Center
Sittig, D. F., Classen, D. C., & Singh, H. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002988 · Cited by 28 · see citing works
Borycki, E. M. (2013) · Healthcare Informatics Research · doi:10.4258/hir.2013.19.2.69 · Cited by 26 · see citing works
“There is general agreement among researchers and policymakers that technology-induced errors arise from a number of sources [10-16,18-20].”
BackgroundInfluentialRights and responsibilities of users of electronic health records
Sittig, D. F., & Singh, H. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111599 · Cited by 28 · see citing works
Measuring the effects of computer downtime on hospital pathology processes
Wang, Y., Coiera, E. W., Gallego, B., Perez‐Concha, O., Ong, M., Tsafnat, G., Roffe, D., Jones, G. R. D., & Magrabi, F. (2015) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2015.12.016 · Cited by 27 · see citing works
Self-citationEffect of an electronic medication administration record application on patient safety
Oliveros, N. V., Gramage, T., Menéndez-Conde, C. P., et al. (2017) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12753 · Cited by 27 · see citing works
A nationwide medication incidents reporting system in The Netherlands
Cheung, K., van den Bemt, P. M. L. A., Bouvy, M. L., et al. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000191 · Cited by 26 · see citing works
Human-Computer Interaction, Ethics, and Biomedical Informatics
Hochheiser, H., & Valdez, R. S. (2020) · Yearbook of Medical Informatics · doi:10.1055/s-0040-1701990 · Cited by 24 · see citing works
“Consistent with earlier efforts [6-9], examinations of patient safety reports continue to find evidence of a strong impact of usability problems on EHR safety [10, 11].”
ResultCoiera, E. W. (2013) · The Medical Journal of Australia · doi:10.5694/mja13.10101 · Cited by 24 · see citing works
Self-citationWatbled, L., Marcilly, R., Guerlinger, S., Bastien, J. M. C., Beuscart-Zéphir, M.-C., & Beuscart, R. (2018) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2017.12.014 · Cited by 20 · see citing works
Carman, E.-M., Fray, M., & Waterson, P. E. (2021) · Applied Ergonomics · doi:10.1016/j.apergo.2020.103339 · Cited by 22 · see citing works
Syndromic surveillance for health information system failures: a feasibility study
Ong, M.-S., Magrabi, F., & Coiera, E. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-001144 · Cited by 22 · see citing works
Self-citationSeth, M., Jalo, H., Högstedt, Å., Medin, O., Sjöqvist, B. A., & Candefjord, S. (2024) · Journal of Medical Internet Research · doi:10.2196/54470 · Cited by 29 · see citing works
“…within silos, potentially resulting in delayed information transfer, suboptimal decision-making, and patient harm [7,21,25,26]; for example, a study conducted by Magrabi et al [27] showed that approximately 20% of reported patient safety hazards were linked to deficient information transfer.”
Jabin, M. S. R., Magrabi, F., Hibbert, P. D., Schultz, T., & Runciman, W. B. (2019) · IEEE International Conference on Imaging Systems and Techniques (IST) · doi:10.1109/ist48021.2019.9010109 · Cited by 19 · see citing works
“The bulk of the keywords was drawn from the work of Farah Magrabi (FM) [17].”
BackgroundSelf-citationKinlay, M., Ho, L. M., Zheng, W. Y., Burke, R. A., Juraskova, I., Moles, R. J., & Baysari, M. T. (2021) · Applied Clinical Informatics · doi:10.1055/s-0041-1739196 · Cited by 19 · see citing works
Vélez‐Díaz‐Pallarés, M., Álvarez‐Díaz, A. M., Gramage, T., Oliveros, N. V., Delgado‐Silveira, E., García, M. M., Cruz-Jentoft, A. J., & Bermejo-Vicedo, T. (2017) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-017-0474-y · Cited by 22 · see citing works
Marcilly, R., Schiro, J., Beuscart-Zéphir, M. C., & Magrabi, F. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1691841 · Cited by 20 · see citing works
Self-citationWyatt, K. D., Benning, T. J., Morgenthaler, T. I., & Arteaga, G. M. (2020) · Applied Clinical Informatics · doi:10.1055/s-0040-1717084 · Cited by 16 · see citing works
Hyvämäki, P. J., Sneck, S., Meriläinen, M. H., Pikkarainen, M. A., Kääriäinen, M., & Jansson, M. M. (2023) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2023.105045 · Cited by 17 · see citing works
Tabaie, A., Sengupta, S., Pruitt, Z. M., & Fong, A. (2023) · BMJ Health & Care Informatics · doi:10.1136/bmjhci-2022-100731 · Cited by 18 · see citing works
“17 Instead, these factors are often described in free-text narratives.”
Development of a Preliminary Patient Safety Classification System for Generative AI
Hose, B., Handley, J. L., Biro, J., Reddy, S., Krevat, S. A., Hettinger, A. Z., & Ratwani, R. M. (2025) · BMJ Quality & Safety · doi:10.1136/bmjqs-2024-017918 · Cited by 19 · see citing works
Past and Next 10 Years of Medical Informatics
Ückert, F., Ammenwerth, E., Dujat, C., et al. (2014) · Journal of Medical Systems · doi:10.1007/s10916-014-0074-5 · Cited by 17 · see citing works
“In the design of a CDSS, the interactions between patients, physicians, nurses, information systems and medical devices in the context of the tasksmust be considered holistically [3,7,8,14].”
BackgroundComparing two anesthesia information management system user interfaces: a usability evaluation
Wanderer, J. P., Rao, A. V., Rothwell, S., et al. (2012) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/s12630-012-9771-z · Cited by 16 · see citing works
Martin, G., Arora, S., Shah, N., King, D., & Darzi, A. W. (2019) · Health Informatics Journal · doi:10.1177/1460458219854602 · Cited by 13 · see citing works
“26 Using a deductive approach to analysis, the HITS Framework was employed to categorise statements across the three domains of safe health IT, using health IT safely and monitoring safety 24 with direct excerpts used as illustrative examples.”
BackgroundInfluentialMoghadam, S. T., Hooman, N., & Sheikhtaheri, A. (2022) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2022.104150 · Cited by 16 · see citing works
Electronic approaches to making sense of the text in the adverse event reporting system
Benin, A. L., Fodeh, S. J., Lee, K., Koss, M., Miller, P. L., & Brandt, C. (2016) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21237 · Cited by 15 · see citing works
Health IT for Patient Safety and Improving the Safety of Health IT
Magrabi, F., Mei-Sing, O., & Coiera, E. W. (2016) · Studies in health technology and informatics · doi:10.3233/978-1-61499-635-4-25 · Cited by 14 · see citing works
“Errors can arise from unexpected interactions between system modules or with other systems [12].”
BackgroundInfluentialSelf-citationUnintended consequences of pharmacy information systems: A case study
Rohani, N., & Yusof, M. M. (2022) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2022.104958 · Cited by 13 · see citing works
Zaouter, C., Wehbe, M., Cyr, S., et al. (2013) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-013-9466-1 · Cited by 13 · see citing works
“A recent study has indicated that 70 % of computerrelated medical incidents are caused by a delay in initiating a clinical procedure [18].”
BackgroundNguyen, L., Bakewell, L., Wickramasinghe, N. S., Haddad, P., Muhammad, I., Moghimi, H., Wilde, D., Redley, B., Considine, J., & Botti, M. (2015) · Cited by 13 · see citing works
Etablierung einer Telenotarzt-Anwendung
Kuntosch, J., Brinkrolf, P., Metelmann, C., Metelmann, B., Fischer, L., Hirsch, F., Süss, R., Fleßa, S., Kozlowski, T., Rübsam, M.-L., et al. (2020) · Springer eBooks · doi:10.1007/978-3-662-61930-8_4 · Cited by 9 · see citing works
Essential activities for electronic health record safety: A qualitative study
Ash, J. S., Singh, H., Wright, A., Chase, D., & Sittig, D. F. (2020) · Health Informatics Journal · doi:10.1177/1460458219833109 · Cited by 12 · see citing works
Hellot-Guersing, M., Jarre, C., Molina, C., Leromain, A., Derharoutunian, C., Gadot, A., & Roubille, R. (2015) · Annales Pharmaceutiques Françaises · doi:10.1016/j.pharma.2015.06.001 · Cited by 12 · see citing works
Borycki, E. M., Kushniruk, A. W., & Carvalho, C. (2013) · Computational and Mathematical Methods in Medicine · doi:10.1155/2013/526419 · Cited by 12 · see citing works
“These studies have found there to be instances where HISs have contributed to potential and real harms/deaths in patients [4, 7, 17].”
BackgroundMoghadam, S. T., Hooman, N., & Sheikhtaheri, A. (2022) · Studies in health technology and informatics · doi:10.3233/shti220362 · Cited by 12 · see citing works
Moghadam, S. T., Sheikhtaheri, A., & Hooman, N. (2023) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2023.104549 · Cited by 11 · see citing works
Ong, M., Sylvia Pelayo, A., & Issues, S. E. F. T. I. Y. S. O. H. F. A. O. (2015) · Yearbook of Medical Informatics · doi:10.15265/iy-2015-033 · Cited by 9 · see citing works
“While health information technology (HIT) promises to enhance patient care quality, safety, and efficiency, significant concerns about its unintended consequences have been raised [1-3].”
BackgroundSelf-citationEffect of EHR User Interface Changes on Internal Prescription Discrepancies
Sawarkar, A., Dementieva, Y. A., Breydo, E. M., Ramelson, H. Z., & Turchin, A. (2014) · Applied Clinical Informatics · doi:10.4338/aci-2014-03-ra-0023 · Cited by 10 · see citing works
A SYSTEMATIC LITERATURE REVIEW ON SAFE HEALTH INFORMATION TECHNOLOGY USE BEHAVIOUR
Salahuddin, L. B., Ismail, Z., & Abidin, W. Z. (2016) · Jurnal Teknologi · doi:10.11113/jt.v78.8225 · Cited by 9 · see citing works
“Likewise, workarounds were the most common strategies to deal with technical problems which prevented access to patients’ and clinical information [27].”
BackgroundHabli, I., Jia, Y., White, S., Gabriel, G., Lawton, T., Sujan, M., & Tomsett, C. (2019) · Health Informatics Journal · doi:10.1177/1460458219852789 · Cited by 7 · see citing works
“15 In other words, there are many different ways in which HIT could fail to meet its intended purpose (e.g. due to usability, hardware, software and network errors).”
BackgroundUsing patient safety-event report data to assess health-IT safety: benefits and challenges
Howe, J. L., Hettinger, A. Z., & Ratwani, R. M. (2019) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30060-3 · Cited by 8 · see citing works
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Noselli, M., van der Vegt, A. H., Cordeil, M., Campbell, V. K., Wang, A. P., Shetty, A., & Scott, I. A. (2025) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2025.3572494 · Cited by 6 · see citing works
“Evaluation of UIs of AI-CDSS was often absent (7 systems) or of poor quality (8 systems) which hinders our ability to assess the comparative value of different UI designs which may, if deployed in clinical practice, result in poor adoption levels or potentially unsafe patient care [68], [81], [82].”
Kang, H., Wang, F., Zhou, S., Qi, M., & Gong, Y. (2017) · Studies in health technology and informatics · doi:10.3233/978-1-61499-830-3-1048 · Cited by 6 · see citing works
A Systems Model of HIT-Induced Complexity
Kuziemsky, C. E., & Ghazzawi, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-10940-0_16 · Cited by 6 · see citing works
Jabin, M. S. R. (2026) · Frontiers in Digital Health · doi:10.3389/fdgth.2026.1786358 · Cited by 6 · see citing works
Safety Use of Hospital Information Systems: A Preliminary Investigation
Salahuddin, L. B., & Ismail, Z. (2015) · Lecture notes in business information processing · doi:10.1007/978-3-319-21009-4_52 · Cited by 5 · see citing works
Iqbal, A. R., Parau, C. A., Kazi, S., Adams, K., La, L., Hettinger, A. Z., & Ratwani, R. M. (2021) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2021.09.004 · Cited by 5 · see citing works
- Authors
- Magrabi, F., Ong, M.-S., Runciman, W., & Coiera, E.
- Affiliations
- UNSW Sydney (AU)
- University of South Australia (AU)
- Corresponding author
- Magrabi, Farah
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-11
- Volume
- 17
- Issue
- 6
- Pages
- 663-670
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC3000751
- OpenAlex
- W2127433315
- Semantic Scholar
- bdc378bbf6e6f3103cce3c62c6eadd155032f3d8
- Cited by
- 162
- References
- 35
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 10 · 2023: 9 · 2022: 8 · 2021: 8 · 2020: 4 · 2019: 14 · 2018: 7 · 2017: 10 · 2016: 14 · 2015: 24 · 2014: 8 · 2013: 17 · 2012: 12
- FWCI
- 16.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- University of New South Wales
- Australian Research Council (DP0772487, LP0775532)
- National Health and Medical Research Council (568612)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- incident classification, human-computer interaction, health information technology, medical information retrieval, user interface design, incident reporting, medical errors, rework, inter-rater reliability
- MeSH terms
- Australia, Computer Systems, Humans, Medical Informatics, Risk Management, User-Computer Interface, Information Storage and Retrieval, Medical Errors, Equipment Failure Analysis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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