Health information technology and converging technologies have been found to contribute to medical errors. Care must be taken when implementing new technology. Contributing factors include:
- Inadequate technology planning can result in poor product selection, a solution that does not adapt well to the local clinical environment, or insufficient testing or training
- Failing to include front-line clinicians in the planning process
- Failing to consider the costs and resources needed for ongoing maintenance
- Failure to consult product safety reviews or alerts or the previous experience of others
- Implementing new clinical information systems can expose latent problems or flawed processes with existing manual systems
- An over-reliance on vendor advice can lead to problems
- Learning to use new technologies takes time and attention, sometimes placing strain on demanding schedules
- Failure to quickly fix technology when it becomes counterproductive can lead to dangerous workarounds
- Excessive alerts lead to alert fatigue, where staff overlook important alerts
Examine workflow processes and procedures for risks and inefficiencies and resolve these issues before any technology implementation. Whether they are clinical, clerical, or technical, involving all disciplines will help examine and resolve these issues.
Actively involve clinicians and staff who will ultimately use or be affected by the technology and IT staff with strong clinical experience in the planning, selection, design, reassessment, and ongoing quality improvement of technology solutions, including the system selection process. Involve a pharmacist in the planning and implementation of any technology that involves medication.
Assess the organization's technology needs beforehand (e.g., supporting infrastructure, communication of admissions, discharges, transfers, etc.). Investigate how best to meet those needs by requiring IT staff to interact with users outside their facility to learn about potential systems' real-world capabilities, including those of various vendors; conduct field trips; and look at integrated systems to minimize reliance on interfaces between various vendor systems.
When introducing new technology, continuously monitor for problems, and address any issues as quickly as possible, particularly problems obscured by workarounds or incomplete error reporting. During the early post-live phase, consider implementing an emergent issues desk staffed with project experts and champions to help rapidly resolve critical problems. Use interdisciplinary brainstorming methods for improving system quality and giving feedback to vendors.
Establish a training program for all types of clinicians and operations staff using the technology and provide frequent refresher courses. Training should be appropriately designed for the local staff. Training programs should focus on how the technology will benefit patients and staff, i.e., less inefficiency, fewer delays, and less repetitive work. Do not allow long delays between orientation and system implementation.
Develop and communicate policies delineating staff authorized and responsible for technology implementation, use, oversight, and safety review. Before taking a technology live, ensure that all standardized order sets and guidelines are developed, tested on paper, and approved by the Pharmacy and Therapeutics Committee or institutional equivalent.
Develop a graduated system of safety alerts in the new technology that helps clinicians determine urgency and relevancy. Carefully review skipped or rejected alerts as important insight into clinical practice. Decide which alerts need to be hard stops when using the technology and provide appropriate supporting documentation. Develop a system that mitigates potential harmful Computerized Provider Order Entry (CPOE) drug orders by requiring departmental or pharmacy review and sign-off on orders created outside the usual parameters. Use the Pharmacy and Therapeutics Committee (or institutional equivalent) to oversee and approve all electronic order sets and clinical decision support alerts. Assure proper nomenclature and printed label design, eliminate dangerous abbreviations and dose designations, and ensure Medication Administration Record (MAR) acceptance by nurses.
To improve safety, provide an environment that protects staff involved in data entry from undue distractions when using the technology. After implementation, continually reassess and enhance safety effectiveness and error-detection capability, including error tracking tools and the evaluation of near-miss events. Maximize the potential of technology to maximize safety benefits.
After implementation, continually monitor and report errors and near misses or close calls caused by technology through manual or automated surveillance techniques. Pursue system errors and multiple causations through the root cause analysis process11 or other forms of failure-mode analysis. Consider reporting significant issues to well-recognized external reporting systems.
Re-evaluate the applicability of security and confidentiality protocols as more medical devices interface with the IT network. Reassess HIPAA compliance periodically to ensure that medical devices' addition to the IT network and the IT department's growing responsibilities have not introduced new security and compliance risks.