Tackling new technology

Please turn off all electronic devices’ we are asked before the plane takes off, ‘they may interfere with the aircraft’s navigation system’; the unintended consequence of new technology, creating the potential for error and harm that was unforeseen when mobile phones were developed. I have often wondered how they found out; did a plane change direction when the captain made a phone call? Here is an example of where the potential for error and harm may go undetected or the cause of an adverse event may not be immediately obvious.

Just as technology has contributed to the improvements in the safety of air travel, so technology through eHealth is offering improvements to the safety of healthcare. Simple forcing functions ensure that the necessary tests that accompany a prescribed medication are ordered. Electronic medical records ensure that essential patient information is available to all members of the healthcare team. Electronic prescribing has reduced the many errors caused by poor handwriting. Robots and bar coding in pharmacies are reducing the errors associated with selecting the wrong pack from the shelf because it looked the same as something else. Decision support systems are helping doctors diagnose as well as helping to calculate the correct dose of drugs where multiple drugs may interact or where complex calculations are needed for small children.

Several projects funded earlier this year under the EU’s Seventh Framework programme for Research are now looking at ways of using technology to predict when errors are likely to happen and to put in place alerts and mechanisms to overcome these risks. But life is never straightforward, especially when people are involved. When an automated drug dispensing system was introduced in an emergency department, it was not intended that the nurses would start carrying urgent drugs like adrenaline in their pockets but this is what happened after the system shutdown temporarily causing a near disaster situation. Neither was it intended for nurses to stick ‘post-it’ notes on the front of the computer to remind them of things that they were unable to put into the hospital system.

In both these cases the staff developed ways of overcoming problems with the new technology that improved patient safety for them. In both cases new potential for error was introduced that would go undetected unless there was an adverse event or near miss that staff felt important to report – or crucially, felt able to report. How would you report the fact that you mistook a label stuck to the screen of a computer as belonging to the wrong patient? The label shouldn’t have been there. How would you report the mistaken dose of adrenaline? The drug shouldn’t have been in your pocket. It is vital for patient safety that healthcare staff report unsafe situations; where reports are investigated and action taken to improve safety; where there is a culture of learning and improving.

eHealth offers a new challenge to organisations in understanding and detecting risk and in encouraging staff to report. We each have a different attitude to technology, often thinking that the reason it didn’t work was because we pressed the wrong button: “it was my silly fault” rather than it being a fault with the technology, so we don’t report it. We also have a tendency to switch off and re-boot the machine when something goes wrong, offering the potential to lose information but more importantly, losing the potential to find out what the problem was, to recreate the situation and find out why it happened.

With the increase of eHealth in the home we also need to consider how patients and families use the technology and report problems. The Institute of Medicine’s report on medical error and harm in 1999 was arguably the most important call to action for patient safety. The report was called ‘To err is human’. If humans ‘err’, what should we call the report we need on eHealth and patient safety? We must draw together all that we currently know on this vital subject and provide a platform to ensure that over the next 10 years, across the EU, the potential of eHealth to improve patient safety exceeds the contribution that technology has made to the safety of air travel.

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