A regulatory perspective on the influence of health information technology on organisational quality and safety in England

Health information technology can transform and enhance the quality and safety of care, but it may also introduce new risks. This study analysed 130 healthcare regulator inspection reports and organisational digital maturity scores in order to characterise the impact of health information technology on quality and safety from a regulatory perspective. Although digital maturity and the positive use of health information technology are significantly associated with overall organisational quality, the negative effects of health information technology are frequently and more commonly identified by regulators. The poor usability of technology, lack of easy access to systems and data and the incorrect use of health information technology are the most commonly identified areas adversely affecting quality and safety. There is a need to understand the full risks and benefits of health information technology from the perspective of all stakeholders, including patients, end-users, providers and regulators in order to best inform future practice and regulation.

[1]  N. Mays,et al.  Assessing quality in qualitative research , 2000, BMJ : British Medical Journal.

[2]  D. Blumenthal,et al.  The benefits of health information technology: a review of the recent literature shows predominantly positive results. , 2011, Health affairs.

[3]  D. Demeritt,et al.  Intelligent Monitoring? Assessing the ability of the Care Quality Commission's statistical surveillance tool to predict quality and prioritise NHS hospital inspections , 2016, BMJ Quality & Safety.

[4]  N. Powe,et al.  Clinical information technologies and inpatient outcomes: a multiple hospital study. , 2009, Archives of internal medicine.

[5]  Alison M. Devlin,et al.  Readiness for Delivering Digital Health at Scale: Lessons From a Longitudinal Qualitative Evaluation of a National Digital Health Innovation Program in the United Kingdom , 2017, Journal of medical Internet research.

[6]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[7]  D. Chang,et al.  A national analysis of the relationship between hospital volume, academic center status, and surgical outcomes for abdominal hysterectomy done for leiomyoma. , 2009, Journal of the American College of Surgeons.

[8]  Hardeep Singh,et al.  Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol , 2013, BMC Medical Informatics and Decision Making.

[9]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[10]  Dean F. Sittig,et al.  Electronic health records and national patient-safety goals. , 2012, The New England journal of medicine.

[11]  Michael F. Furukawa,et al.  Electronic Health Record Adoption and Rates of In-hospital Adverse Events , 2016, Journal of patient safety.

[12]  W. Currie,et al.  A cross-national analysis of eHealth in the European Union: Some policy and research directions , 2014, Inf. Manag..

[13]  D. Khullar,et al.  Association Between Teaching Status and Mortality in US Hospitals , 2017, JAMA.

[14]  Edward E. Etchells,et al.  eWasted time: Redundant work during hospital admission and discharge , 2016, Health Informatics J..

[15]  Judith Belle Brown,et al.  Family physicians' perspectives on personal health records: qualitative study. , 2011, Canadian family physician Medecin de famille canadien.

[16]  Ara Darzi,et al.  A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review , 2016, Journal of medical Internet research.

[17]  Dean F. Sittig,et al.  Review of Reported Clinical Information System Adverse Events in US Food and Drug Administration Databases , 2011, Applied Clinical Informatics.

[18]  Harpreet Sood,et al.  Chief clinical information officers: clinical leadership for a digital age , 2017, British Medical Journal.

[19]  Christian Nøhr,et al.  A comparative review of patient safety initiatives for national health information technology , 2013, Int. J. Medical Informatics.

[20]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[21]  P. Salmon Assessing the quality of qualitative research. , 2013, Patient education and counseling.

[22]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[23]  Sowmya R. Rao,et al.  Use of electronic health records in U.S. hospitals. , 2009, The New England journal of medicine.

[24]  Christine A. Sinsky,et al.  Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction. , 2016, Mayo Clinic proceedings.

[25]  H. Rothstein,et al.  ‘RENEWING DEFRA’: EXPLORING THE EMERGENCE OF RISK‐BASED POLICYMAKING IN UK CENTRAL GOVERNMENT , 2012 .

[26]  Dean F Sittig,et al.  The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records. , 2014, The American journal of managed care.

[27]  Jeremy C Wyatt,et al.  Opportunities for and challenges of computerisation , 1998, The Lancet.

[28]  Steffie Woolhandler,et al.  Hospital computing and the costs and quality of care: a national study. , 2010, The American journal of medicine.

[29]  Dean F Sittig,et al.  Measuring and improving patient safety through health information technology: The Health IT Safety Framework , 2015, BMJ Quality & Safety.

[30]  J. Perlin Transformation of the US Veterans Health Administration , 2006, Health Economics, Policy and Law.

[31]  Michael W. Smith,et al.  An analysis of electronic health record-related patient safety concerns , 2014, J. Am. Medical Informatics Assoc..

[32]  A. Jha,et al.  Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. , 2003, The New England journal of medicine.

[33]  Spencer S. Jones,et al.  Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use , 2014, Annals of Internal Medicine.

[34]  Ara Darzi,et al.  WannaCry—a year on , 2018, British Medical Journal.

[35]  S. Shaha,et al.  The Growing Gap in Electronic Medical Record Satisfaction Between Clinicians and Information Technology Professionals: Issues of Most Concern and Suggested Remediations. , 2015, The Journal of bone and joint surgery. American volume.

[36]  Eta S. Berner,et al.  Hospital Budget Increase for Information Technology During Phase 1 Meaningful Use , 2015, The health care manager.

[37]  Farah Magrabi,et al.  Clinical safety of England's national programme for IT: A retrospective analysis of all reported safety events 2005 to 2011 , 2015, Int. J. Medical Informatics.

[38]  K. Saranto,et al.  Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users , 2016, JMIR medical informatics.

[39]  Farah Magrabi,et al.  An analysis of computer-related patient safety incidents to inform the development of a classification , 2010, J. Am. Medical Informatics Assoc..

[40]  Dean F Sittig,et al.  A new sociotechnical model for studying health information technology in complex adaptive healthcare systems , 2010, Quality and Safety in Health Care.

[41]  Jeffrey S McCullough,et al.  Health information technology and patient safety: evidence from panel data. , 2009, Health affairs.

[42]  Ara Darzi,et al.  Cybersecurity and healthcare: how safe are we? , 2017, British Medical Journal.

[43]  David M. Liebovitz,et al.  Use of more than one electronic medical record system within a single health care organization , 2012, Applied Clinical Informatics.

[44]  Robert L. Wears,et al.  Health information technology: fallacies and sober realities , 2010, J. Am. Medical Informatics Assoc..

[45]  D J Spiegelhalter,et al.  Using routine intelligence to target inspection of healthcare providers in England , 2009, Quality & Safety in Health Care.

[46]  Jonathan P. Weiner,et al.  Comment: "e-Iatrogenesis": The Most Critical Unintended Consequence of CPOE and other HIT , 2007, J. Am. Medical Informatics Assoc..

[47]  Karl A. Stroetmann,et al.  United in Diversity: Legal Challenges on the Road Towards Interoperable eHealth Solutions in Europe , 2012 .

[48]  Ross Koppel Monitoring and evaluating the use of electronic health records. , 2010, JAMA.

[49]  I. Torjesen CQC sets out new inspection regime for hospitals in England , 2013, BMJ.