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Using information technology to improve patient safety

A recent World Health Organization (WHO) Working Group that I chaired examined the potential of information technology to improve patient safety. The report from the working group was published in the journal Quality & Safety in Healthcare. Previous research has identified as significant issues the substantial variations in the quality and safety of healthcare that patients receive; and the considerable risks of iatrogenic harm to patients. These failings contribute to the high rates of potentially avoidable morbidity and mortality; and to the rising levels of healthcare expenditure seen in many health systems. There have been substantial developments in information technology in recent decades and there is now real potential to apply these technological developments to improve the provision of healthcare.

One area of international interest is the use of eHealth applications to address patient safety and quality issues. There is, however, a large gap between the theoretical and empirically demonstrated benefits of current eHealth applications. While these applications typically have the technical capability to help professionals in the delivery of healthcare, inadequate attention to the socio-technical dimensions of their use (such as user involvement in their development and in training in their use) can result in new risks to patients. Given the current lack of evidence on quality and safety improvements and on the costs & benefits associated with the introduction of eHealth applications, there should be a focus on implementing more mature technologies; it is also important that eHealth applications should be evaluated against a comprehensive and rigorous set of measures, ideally at all stages of their application life cycle.

A key step in using information technology is through introducing the use of electronic patient record systems; these systems lie at the heart of many eHealth technologies, such as electronic prescribing and computerised test ordering, as well as providing data for the identification of potential threats to patient safety. However, the introduction of electronic patient records can bring its own threats to patient safety, particularly in the early stages, when healthcare providers could be using electronic and paper-based records in parallel. One consequence of this dual usage is that the data held in electronic patient record systems can be inaccurate or incomplete, with the potential to compromise patient safety because key data items (e.g., drug allergies or important comorbidities) might not be recorded. Other key steps are to ensure the full engagement of clinicians and other professionals, and to provide adequate training to allow them to use eHealth solutions appropriately. It is also important that methods for effective data interchange between IT systems are in place if the full benefits are to be realised, and to limit the workload and errors that can arise from duplicate and unnecessary data entry.


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