Ensuring the Safety of Health Information Systems: Using Heuristics for Patient Safety




Carvalho, Christopher J.
Borycki, Elizabeth M.
Kushniruk, Andre

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Longwoods Publishing


Health information systems (HISs) are typically seen as a mechanism for reducing medical errors. However, there is evidence to suggest that technology can facilitate or induce medical errors. Therefore, it is crucial that we fully test systems prior to their implementation in real-world settings. Presently, evidence-based evaluation heuristics that are specific to HISs do not exist for assessing aspects of interface design that may facilitate errors. A three-phase study was conducted to determine the utility of evidence-based heuristics in evaluating a human-technology interface (i.e., the Veterans Affairs Computerized Patient Record System [VA CPRS®]). Phase one consisted of a systematic review of the health informatics literature involving technology-facilitated or technology-induced error. Phase two involved reviewing the literature and generating a comprehensive list of 38 heuristics that could be used to evaluate an HIS for technology-induced errors. Lastly, phase three involved conducting a heuristic evaluation of the VA CPRS® system using evidence-based heuristics. Results from this work are discussed. According to a recent paper by Baker et al. (2004), approximately 185,000 hospital admissions in Canada result from an adverse event. Several studies published over the past two decades have demonstrated the effectiveness of HISs in reducing the number of adverse events and improving healthcare practitioner performance (Ash et al. 2007). Largely based on this literature, healthcare administrators have decided to invest in HISs (e.g., computerized provider order entry [CPOE], pharmacy systems, decision support systems and medication administration systems) for their organizations to reduce the number of adverse events arising from medical errors. However, in the past five years, several researchers have documented the potential of HISs to introduce new types of errors, called technology-induced or -facilitated errors (Koppel et al. 2005; Kushniruk et al. 2005). The number of studies with these findings continues to grow. Therefore, it is crucial that any potential negative effects of HISs must be considered and methods be developed to ensure HISs are safe prior to their implementation.




Carvalho, C.J., Borycki, E.M. & Kushniruk, A. 2009, "Ensuring the safety of health information systems: using heuristics for patient safety", Healthcare quarterly (Toronto, Ont.), vol. 12, Spec., pp. 49-54.