Yes / This study explored healthcare quality issues affecting the reporting and investigation levels of digital incident
reporting systems.
Methods: A total of 38 health information technology-related incident reports (free-text narratives) were collected from one
of Sweden’s national incident reporting repositories. The incidents were analysed using an existing framework, i.e., the
Health Information Technology Classification System, to identify the types of issues and consequences. The framework
was applied in two fields, ‘event description’ by the reporters and ‘manufacturer’s measures’, to assess the quality of reporting
incidents by the reporters. Additionally, the contributing factors, i.e., either human or technical factors for both fields,
were identified to evaluate the quality of the reported incidents.
Results: Five types of issues were identified and changes made between before-and-after investigations: Machine to software-
related issues (n = 8), machine to use-related issues (n = 5), software to software-related issues (n = 5), use to software-
related issues (n = 4) and use to use-related issues (n = 1). Over two-thirds (n = 15) of the incidents demonstrated a
change in the contributing factors after the investigation. Only four incidents were identified as altering the consequences
after the investigation.
Conclusion: This study shed some light on the issues of incident reporting and the gap between the reporting and investigation
levels. Facilitating sufficient staff training sessions, agreeing on common terms for health information technology systems,
refining the existing classifications systems, enforcing mini-root cause analysis, and ensuring unit-based local
reporting and standard national reporting may help bridge the gap between reporting and investigation levels in digital
incident reporting.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/19442 |
| Date | 08 May 2023 |
| Creators | Md Shafiqur Rahman, Jabin,, Steen, Mary, Wepa, Dianne, Bergman, Patrick |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Article, Published version |
| Rights | (c) 2023 The Authors. This is an Open Access article distributed under the Creative Commons CC-BY license (https://creativecommons.org/licenses/by/4.0/), CC-BY |
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