Research to improve IT systems in healthcare
Our classification of human factors and technical problems that contribute to IT incidents in healthcare has been used by multiple government agencies and patient safety organisations.
Project sponsor: National Health and Medical Research Council Project Grant (APP1022946, 630583)
About the project
The systematic analysis of critical incidents is well-established in medical practice. Incidents can trigger root-cause analyses in health services, or provide early warnings of unexpected drug reactions or infectious outbreaks. Our research has extended these methods to incidents associated with digital health (ie patient harm due to an IT problem or difficulty in using software).
Project goals
The aim of this project was to:
- detect IT incidents
- develop a robust classification for IT incidents
- use the classification to track the evolving causes of IT-related harm in Australia
- promulgate the classification internationally.
We have developed a classification for problems associated with IT systems in healthcare that takes a bottom-up approach and was developed by examining 'natural categories' of problems described in incidents from a range of health care settings in Australia, the USA and England.
The classification was initially based on incidents reported to a state-wide system in Australia, and then expanded with new categories for software problems using incidents from the US Food and Drug Administration over a 30-month period. It was subsequently validated with 850 incidents reported in the English National Health Service over a six-year period, and a further 90 incidents reported by Australian GPs over a 19-month period.
The classification was further validated by a 2017 systematic review of problems with health IT which found that no new categories were required to code the IT problems, information errors, and contributing factors identified in the 34 studies included in this review.
Beyond the published literature, this classification was endorsed by the American Nursing Informatics Association in their 2015 position paper on IT safety.
- 2018 – adopted by the International Organization for Standardization (ISO) as the basis for a new technical specification to improve reporting about the safety of health software.
- 2019 – adapted for the Australian Safety and Quality Commission's guidance for hospitals nationally.
- Implemented into the provincial incident monitoring system in British Columbia, Canada.
- Used by multiple government agencies and patient safety organisations including the Australian Digital Health Agency, the US Joint Commission and the Emergency Care Research Institute (ECRI).
We welcome enquiries about our classification and are happy to assist individuals and organisations who wish to use the schema to analyse digital health incidents. A guide to the classification is also available.
Project lead: Professor Farah Magrabi
Other members and collaborators
- Professor Marie-Catherine Beuscart-Zéphir, Université de Lille Nord de France, France
- Professor Michael Kidd, Faculty of Medicine, Nursing and Health Sciences, Flinders University
- Professor Siaw-Teng Liaw, School of Public Health and Community Medicine, UNSW Medicine
- Professor Christian Nohr, Danish Centre for Health Informatics, Department of Development and Planning, Aalborg University, Denmark
- Professor Bill Runciman, University of South Australia and Australian Patient Safety Foundation
- Professor Dean Sittig, University of Texas – Memorial Hermann Center for Healthcare Quality & Safety, Houston, Texas
- Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review
- Identifying patient safety problems associated with information technology in general practice: An analysis of incident reports
- Clinical safety of England's national programme for IT: a retrospective analysis of all reported safety events 2005 to 2011
- Using FDA reports to inform a classification for health information technology safety problems
- Patient safety problems associated with heathcare information technology: an analysis of adverse events reported to the US Food and Drug Administration
- An analysis of computer-related patient safety incidents to inform the development of a classification.