Methodological Review: The Technology Acceptance Model: Its past and its future in health care

Healthcare practitioners, patient safety leaders, educators and researchers increasingly recognise the value of human factors/ergonomics and make use of the discipline's person-centred models of sociotechnical systems. This paper first reviews one of the most widely used healthcare human factors systems models, the Systems Engineering Initiative for Patient Safety (SEIPS) model, and then introduces an extended model, 'SEIPS 2.0'. SEIPS 2.0 incorporates three novel concepts into the original model: configuration, engagement and adaptation. The concept of configuration highlights the dynamic, hierarchical and interactive properties of sociotechnical systems, making it possible to depict how health-related performance is shaped at 'a moment in time'. Engagement conveys that various individuals and teams can perform health-related activities separately and collaboratively. Engaged individuals often include patients, family caregivers and other non-professionals. Adaptation is introduced as a feedback mechanism that explains how dynamic systems evolve in planned and unplanned ways. Key implications and future directions for human factors research in healthcare are discussed.

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SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients

We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. RESULTS We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) — a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the barcode eMAR but were completely eliminated on units that did use it. CONCLUSIONS Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)

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Effect of Bar-Code Technology on the Safety of Medication Administration

https://isiarticles.com/bundles/Article/pre/pdf/22229.pdf

Human factors systems approach to healthcare quality and patient safety

of “Roadmap for Provision of Safer Healthcare Information Systems: Preventing eIatrogenesis” Joan S. Ash, Ph.D., M.L.S., M.B.A.; Charles M. Kilo, M.D., M.P.H.; Michael Shapiro, M.A., M.S.; Joseph Wasserman, B.A.; Carmit McMullen, Ph.D.; William Hersh, M.D. BACKGROUND AND METHODS e-Iatrogenesis, defined as “patient harm caused at least in part by the application of health information technology” (Weiner et al., 2007), is of increasing concern as more and more hospitals are implementing health information systems (HIS). This report assesses how HIS can be designed, developed, implemented, monitored, and maintained to maximize safety. We specifically focus on hospital electronic health records (EHRs), clinical decision support (CDS), and computerized provider order entry (CPOE) systems. This white paper is intended to provide background for an Institute of Medicine (IOM) report on how the use of health information technology affects the safety of patient care by answering the following IOM-posed questions: • What are the risks of health care information systems that arise from workflow and related issues? • How have organizations acted to implement health care information systems safely? • What are the impacts of customization on safety? • What is the industry approach to managing change and customization? A recent literature review by Harrington et al. (2011) has summarized the EHR safety literature, so we first reviewed all papers cited in their report. Of their 43 references, we identified 37 that were relevant to the scope of this article. We analyzed the bibliographies of these selected papers and performed a reverse bibliography search on the articles deemed most relevant and published since 2000. In total, we identified over 100 sources relevant to the scope of this report. We then targeted topics for which published evidence was lacking and conducted several interviews with experts to help fill the knowledge gaps. 1 Full commissioned paper can be found in this project’s Public Access File. C-2 HEALTH IT AND PATIENT SAFETY PREPUBLICATION COPY: UNCORRECTED PROOFS RESULTS What Are the Risks of Health Information Systems That Arise from Workflow and Related Issues? We found seven publications (Chuo and Hicks, 2008; Joint Commission on Accreditation of Healthcare Organizations, 2008; Magrabi et al., 2010; Myers et al., 2011; Santell et al., 2009; Walsh et al., 2006; Zhan et al., 2006) presenting results of assessments of e-iatrogenic risk. All are studies of large databases of reported errors and they consistently indicate low levels of HISrelated risk, under 1 percent of all errors. All point to the need for human diligence when using HIS. Specifically, they indicate that HIS-related errors are due to inadequate staffing levels, lack of user experience, mislabeled bar-codes on medications, human distraction, inaccurate data entry, system downtime, and missing data. How Have Organizations Acted to Implement Health Information Systems Safely? Prior to implementation, health care organizations can mitigate risk. There is a large literature base devoted to the risks inherent in commercial EHR systems, and also warnings about their impact on workflow. Many publications offer guidance to hospitals about assessing workflow, selecting systems for purchase, conducting simulation tests, training, and other mechanisms for ensuring safe HIS implementation. Numerous publications exist to guide the implementation process itself, but there are also several pointing to the risks of rapid implementation without appropriate preparation. Finally, after implementation, continuous monitoring and improvement can mitigate safety risks. What Are the Impacts of Customization on Safety? The literature indicates that customization of the EHR to fit local situations seems to be necessary for many reasons, but there is scant research on how much customization or what form of customization is needed to optimize EHR use and what the risks are from either too much or too little customization. The content of CDS likewise needs adaptation, especially to avoid alert fatigue. Any customization must be done with care so that system upgrades can be accommodated. What Is the Industry Approach to Managing Change and Customization? The current industry approach is fragmented; a report sponsored by the Agency for Healthcare Research and Quality describes a wide variety of vendor practices related to usability of systems (McDonnell et al., 2010). Because purchasers must usually customize systems to fit local workflows and regulations, HIS safety depends on a combination of industry and local diligence.

Health IT and Patient Safety: Building Safer Systems for Better Care

Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety.

Conclusion Twenty-seven Paradoxes, Ironies, and Challenges of Patient Safety

Handoffs-transfer of patient care from one clinician or service to another-are well known patient safety dangers. Healthcare Information Technology (HIT) as an intervening and powerful force in handoffs has received comparatively little attention. The role of HIT in concert with paper documentation has received even less attention. We analyze handoffs in relation to electronic records and hybrid systems (both paper and HIT) to identify sources of error and miscommunication. We propose a typology of handoffs and illustrate several of them.

Joel Leon Telles

Papers

Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety.

Conclusion Twenty-seven Paradoxes, Ironies, and Challenges of Patient Safety

Role of Healthcare Information Technology in handoffs.