The Commission contributes to e-Health safety by optimising safety and quality in the rollouts of digital clinical systems. It focuses on hospital medication management programs and discharge summaries, and uses e-Health initiatives to improve the safety and quality of health care, including antimicrobial stewardship.
e-Health safety programs and resources
The Commission’s e-Health safety programs include:
- Certification framework for digital mental health services
- Electronic discharge summary (EDS) systems
- Electronic medication management (EMM) systems in hospitals
- My Health Record clinical safety program
- My Health Record Guide
- My Health Record in emergency departments project
- National guidelines for on-screen display of medicines information
- Safety Issues at Transitions of Care: Pain points relating to clinical systems
- Structured microbiology requests and reporting of healthcare-associated infections
The Commission works in collaboration with states and territories, the private hospital and primary care sectors, the Australian Digital Health Agency (the Agency), and other national bodies to promote the safety and quality agenda within national digital programs.
e-Health literature reviews
The Commission appointed Sydney University to develop a literature review The Impact of Digital Health on Safety and Quality of Health Care. The review analyses evidence for the types of digital health interventions which have been shown to improve health care. It focuses on the safety and quality impact of five digital health interventions:
- Clinical decision-support systems (CDSSs)
- Computerised provider order entry (CPOE) including electronic prescribing
- Electronic patient portals
- Electronic patient reminders (mobile technologies)
- Information-sharing at discharge (electronic discharge summary or EDS).
The findings from the literature review will support jurisdictions, the Agency, and other healthcare providers to identify best-value approaches to digital health initiatives.
HIT-related patient safety incidents
Literature on the clinical safety of health information technology (HIT) systems is rapidly evolving as these systems roll out. The Commission asked the Australian Institute of Health Innovation at Macquarie University to perform a literature review and environmental scan on approaches to the review and investigation of Health IT-related patient safety incidents to:
- Identify appropriate methods for monitoring hazards affecting HIT systems
- Investigate incidents resulting from the use of these systems.
A Literature review and environmental scan on approaches to the review and investigation of Health IT-related patient safety incidents published in 2017 found that the requirements for HIT safety systems:
- Are similar to those that apply to existing patient safety systems
- Should include the ability to identify hazards ahead of time and permit review of incidents after the event
- Should also provide information about the prevalence of incident reporting and management systems
- Should allow the opportunity to classify and report on incidents to ensure a continuous open loop of feedback and improvement.
The review noted that numerous methodologies exist and that no single method was appropriate to detect, investigate and classify all HIT incidents. Successful HIT safety systems need to have in place a multidisciplinary team with appropriate skill sets from a clinical, health informatics and system safety perspectives and use a tailored approach to investigate HIT patient safety incidents.
As HIT systems are being implemented in most Australian states and territories, and some private hospitals, HIT-related safety risks continue to be unintended consequences from their implementation. Complex and difficult issues, to which implementation teams must be alert, are arising, and little is known about the types of errors that may be associated with:
- EMM-related work practice changes
- Clinicians working across multiple sites and settings, and remote ordering
- Hybrid environments in which EMM and hard-copy documentation for prescribing and administration of medicines, are both used
- Multiple EMM systems, such as separate ICU or oncology systems
- Multiple patient EMM records being open at the one time
- Selection errors associated with use of ‘drop-down’ medicine lists when prescribing
- Dosing errors associated with on-screen presentation of medicines information
- Decision support information not being used, not readily accessible for use, or not considered relevant (interaction alerts) by clinicians
- Planned and unplanned downtime.
In 2019 the Commission repeated the literature review An update on approaches to the review and investigation of health IT-related patient safety incidents. Key findings:
- Despite a marked number of reported investigations into health IT-related patient safety incidents, no notable developments for using existing taxonomies to classify these events were found
- The literature did not contain examples of data breach incidents relating specifically to EMR design, build and use being routinely recorded and reported.
Guidance for hospitals: EMM incident classification
The development of standardised taxonomies to describe clinical incidents related to EMM systems continues to be a challenge in Australia and internationally with a multitude of classifications available for implementation. Australia required a standardised health IT-related incident classification system that provides a unified and consensus-based approach that can be readily applied during the EMM implementation process.
In 2019, this led to the development of Guidance for hospitals: Classifying EMM-related adverse events and incidents (the Guidance) by the Commission.
The Guidance has been informed by a 2019 Update on approaches to the review and investigation of health IT-related patient safety incidents.
Hospitals will be able to use this information to guide EMM-related adverse event and incident investigation and prioritise health IT-related system improvement.
The Guidance comprises a fact sheet and a set of three (3) tools or classification schema:
- Fact sheet for health service organisations
- Classification of prescribing and medicine administration adverse events and incidents
- Classification for problems associated with IT systems used in healthcare
- Classification of consequences of EMM-related adverse events and incidents
Each tool has been devised, based on national and international approaches to the review and investigation of medicine as well as EMM/CIS-related adverse events and incidents.