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Despite many benefits, the extensive deployment of Health Information Technology (HIT) systems by healthcare organizations has encountered many challenges, particularly in the field of telemetry concerning patient monitoring and its operational workflow. These challenges can add more layers of complexity when an unplanned software security patching is performed, affecting patient monitoring and causing disruption in daily clinical operations. This study is a reflection on what happened associated with software security patching and why it happened through the lens of an incident report to develop potential preventive and corrective strategies using qualitative analyses—inductive and deductive approaches. There is a need for such analyses to identify the underlying mechanism behind such issues since very limited research has been conducted on the study of software patching. The incident was classified as a “software functionality” issue, and the consequence was an “incident with a noticeable consequence but no patient harm”, and the contributing factor was a software update, i.e., software security patching. This report describes how insufficient planning of software patching, lack of training for healthcare professionals, contingency planning on unplanned system disruption, and HIT system configuration can compromise healthcare quality and cause risks to patient safety. We propose 15 preventive and corrective strategies grouped under four key areas based on the system approach and social-technical aspects of the patching process. The key areas are (i) preparing, developing, and deploying patches; (ii) training the frontline operators; (iii) ensuring contingency planning; and (iv) establishing configuration and communication between systems. These strategies are expected to minimize the risk of HIT-related incidents, enhance software security patch management in healthcare organizations, and improve patient safety. However, further discussion should be continued abou

Introduction: Despite many benefits offered by Health Information Technology (HIT) systems, new technology brings new and unforeseen risks to healthcare quality and patient safety if they're not properly planned, designed, implemented, and managed. This study examined health information technology-related (HIT) incidents to identify patient details-related issues, their association with contributing factors, and outcomes. Methods: Sources of information comprised retrospectively collected incident reports (n=95) using two sampling methods, i.e., purposive and snowball sampling. The incident reports were analyzed using both the inductive method (thematic analysis) and the deductive approach using an existing framework, i.e., the International Classification for Patient Safety. Results: The studies identified 90 incidents with 120 patient details-related issues—categorized as either information-related (48%) or documentation-related (52%) problems; around two-thirds of the 120 issues were characterized by human factors. Of the total sample, 87 contributing factors were identified, of which "medical device/system" (45%) and "documentation" (20%) were the most common contributing factors. Of 90 incidents, more than half (59%) comprised patient-related outcomes—patient inconvenience (47%) and patient harm (12%) and the remaining 41% (n=37) included staff or organization-related outcomes. Discussion: More than half of the incidents resulted in patient-related outcomes, namely patient inconvenience and patient harm, including disease risks, severe health deterioration, injury, and even patient death. Incidents associated with patient details can cause deleterious effects; therefore, characterizing them should be a routine part of clinical practice to improve the constantly changing healthcare system.

This study examined health information technology-related incidents to characterise system issues as a basis for improvement in Swedish clinical practice. Incident reports were collected through interviews together with retrospectively collected incidents from voluntary incident databases, which were analysed using deductive and inductive approaches. Most themes pertained to system issues, such as functionality, design, and integration. Identified system issues were dominated by technical factors (74%), while human factors accounted for 26%. Over half of the incidents (55%) impacted on staff or the organisation, and the rest on patients - patient inconvenience (25%) and patient harm (20%). The findings indicate that it is vital to choose and commission suitable systems, design out "error-prone" features, ensure contingency plans are in place, implement clinical decision-support systems, and respond to incidents on time. Such strategies would improve the health information technology systems and Swedish clinical practice.

Background: Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation. Objective: The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. Methods: The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and abstracts and then review the full t

Background:Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. Objective:This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. Methods:The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. Results:A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis.

Objective: To identify a subset of software issues occurring in daily Swedish healthcare practice and devise a set of local solutions to overcome the challenges. Methods: A sample of 46 incident reports was collected from one of Sweden's national incident reporting repositories, ranging from June 2019 to December 2021. The reports were first subjected to an algorithm to identify if they were health information technology-related incidents and were analysed using an existing framework, i.e., the Health Information Technology Classification System, to identify the software-related incidents. The incidents associated with software issues were then subjected to thematic analysis, in which themes were extracted and presented under the category assigned by the existing framework used. Results: Of 46 reports, 45 (with one exception) were included using the algorithm. Of 45 incidents, 31 software-related incidents were identified using the classification system. Six types of software issues were identified, including software functionality (n = 10), interface with other software systems or components (n = 10), system configuration (n = 7), interface with devices (n = 2), record migration (n = 1) and increased volume of transactions (n = 1). Each issue was further categorised into different themes; for example, software interface-related problems were grouped into ‘two patients being active in the system simultaneously’ (n = 6) and ‘transfer of patient information’ (n = 4). Conclusions: The study provided some insights into software issues and relevant consequences. A set of local solutions were devised to overcome the present challenges encountered in Swedish healthcare in their daily clinical practice. Systematic identification and characterisation of such software challenges should be a routine part of clinical practice for all major health information technology implementations.

Objective: This study explored healthcare quality issues affecting the reporting and investigation levels of digital incidentreporting systems. Methods: A total of 38 health information technology-related incident reports (free-text narratives) were collected from oneof Sweden’s national incident reporting repositories. The incidents were analysed using an existing framework, i.e., theHealth Information Technology Classification System, to identify the types of issues and consequences. The frameworkwas applied in two fields, ‘event description’ by the reporters and ‘manufacturer’s measures’, to assess the quality of report-ing 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 soft-ware-related issues (n = 8), machine to use-related issues (n = 5), software to software-related issues (n = 5), use to soft-ware-related issues (n = 4) and use to use-related issues (n = 1). Over two-thirds (n = 15) of the incidents demonstrated achange in the contributing factors after the investigation. Only four incidents were identified as altering the consequencesafter the investigation. Conclusion: This study shed some light on the issues of incident reporting and the gap between the reporting and investi-gation levels. Facilitating sufficient staff training sessions, agreeing on common terms for health information technology sys-tems, refining the existing classifications systems, enforcing mini-root cause analysis, and ensuring unit-based localreporting and standard national reporting may help bridge the gap between reporting and investigation levels in digitalincident reporting.

This study aimed to examine health information technology-related incidents and identify risks associated with multiple patients' management. Sources of information comprised interviews with healthcare professionals and three small sets of local voluntary incident reports using two sampling strategies, purposive and snowball sampling. Incident reports, in the form of free-text narratives, were aggregated for analysis using the Health Information Technology Classification System and thematic analysis. Of 95 incidents, 176 issues were identified, comprising 77% (n=136) technical issues, and 23% (n=40) use or human-related issues. Human issues were over two times more likely to harm patients (OR 2.25, 95% CI 1.01 - 4.98) than technical issues. Incidents that affected multiple patients' care accounted for 70% (n=66) of the total sample, and large-scale events comprised 39% (n=26) of the incidents that affected multiple patients' care. Systematically identifying and characterizing such incidents should be prioritized for health information technology implementations.

Objective: This study explored the Swedish digital health testbeds through the lens of complexity science. Methods: The purposive sampling was used to identify 38 digital health testbed organizations to conduct interviews in written or audio-conferencing. The interview responses were aggregated and analyzed using thematic analysis. The themes were mainly generated through complexity theory and the principles of complex adaptive systems. Results: Fifteen testbed organizations responded, comprising 13 written responses and two audio-conferencing. Five maintheoretical themes were generated: agents and diversity, connections and communication, adaptation and learning, perturbations,and path dependence. Agents and diversity depicted different types of testbeds, stakeholders and innovation, and the primary function and purpose of the testbeds. Various factors enhancing connections and communications among multiple stakeholders were identified, such as the quality of e-health solutions and the 2030 Agenda for Sustainable Development. Some adaptation and learning factors, such as internal reorganization, sharing and creating learning opportunities, and additional funding, guaranteed the sustainability of testbeds. Perturbations were characterized by two factors: non-linear interactions – lack of commitment and transparency in stakeholders’ engagement, and uncertainty about testbed definitions and concepts. Path dependence highlighted the importance of history, such as previous positive and negative experiences. Conclusion: This study provided insights into testbeds’ organization, their functions, how various aspects were challenged,and how they adapted to overcome and improve the system issues. Identifying the stakeholders and relevant factors, commissioning an evaluation, backing up with a contingency plan, securing adequate funding, and disseminating the findings can improve the testbeds’ design and implementation., eHealth Arena

Objective: To identify issues with the Swedish e-prescribing system and devise a set of recommendations to overcome the identified challenges. Methods: A number of health information technology-related incidents were collected retrospectively from various sourcesusing purposive and snowball sampling. A search term containing five keywords was used to identify the electronic prescription-related incidents. The identified incidents (n=24) were subjected to an existing framework, i.e., the HealthInformation Technology Classification System. Special attention was paid to the software-related issues, which were analysed using thematic analysis. Results: Several types of software-related issues (n=22) were identified: system configuration, interface with other softwaresystems or components, software functionality, data storage and backup, record migration, software not accessible, andnetwork/server down or slow. Both human and technical factors contributed to these incidents, including prescriptions not cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These software problems led to various consequences, such as incidents affecting multiple patients’ care management, delays in patient care, and risks of serious deterioration of health. Several temporary initiatives or administrative adjustments, for instance, cover letters to patients and local strategies, were used to overcome some of these challenges. Conclusions: This study provides insights into the challenges related to the e-prescribing system, contributing factors, consequences, and actions taken to mitigate those risks. Therefore, healthcare organisations using the e-prescribing system should adopt the provided recommendations to minimise the risks of design and developmental challenges, implementationand use-related issues, and the problems related to monitoring, evaluation, and optimisation.

Rapporten sammanställer resultatet från två delstudier om digitala testbäddar inom hälso- och sjukvården i Sverige. Den första var en explorativ studie som omfattade 15 digitala testbäddar inom hälso- och sjukvården i Sverige. Den andra var en studie som fokuserade på företag som utvecklar produkter och tjänster inom hälsa, vård och omsorg, för att erhålla företagens perspektiv på testbäddar.

Objective: This study aimed to compile and synthesize evidence regarding the effectiveness of quality improvement interventions in radiology and the experiences and perspectives of staff and patients. Methods: Databases searched for both published and unpublished studies were as follows: EMBASE,MEDLINE, CINAHL, Joanna Briggs Institute,Cochrane Central Register of Controlled Trials, PsycINFO, Scopus,Web of Science, Mednar, Trove, Google Gray, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative studies of patients undergoing radiological examinations and/or medical imaging health care professionals; a broad range of quality improvement interventions including introduction of health information technology, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; context of radiological setting; a broad range of outcomes including patient safety; and a result-based convergent synthesis design. Results: Eighteen studies were selected from 4846 identified by a systematicliterature search. Five groups of interventions were identified: health information technology (n = 6), training and education (n = 6), immediate and critical reporting (n = 3), safety programs (n = 2), and the introduction of mobile radiography (n = 1), with demonstrated improvements in outcomes, such as improved operational and workflow efficiency, report turnaroundtime, and teamwork and communication. Conclusions: The findings were constrained by the limited range of interventionsand outcome measures. Further research should be conducted with study designs that might produce findings that are more generalizable,examine the other dimensions of quality, and address the issues of cost and risk versus benefit.

The Joint Commission in the United States disseminated a Sentinel Event Alert because of the number of adverse outcomes from problems with health information technology (HIT). The HITs were trading off safety and quality against throughput or efficiency. The Alert urged healthcare providers to improve process measurement and provide leadership in mitigating the risks. In order to understand what problems compromise safety and efficiency, this study has accessed,deconstructed, categorized and analyzed Australian patient safety incident reports of the things that go wrong in medical imaging, and their impact on both patients and the medical imaging acquisition and processing systems. Data Sources comprised two sets of voluntary incident reports and convenience samples of interviews with radiology staff. A special targeted search was undertaken for identifying HIT related incidents so that they could be deconstructed with the health information technology classification system. This resulted in 436 HIT related incidents. Within these incidents, 623 HIT related issues were found. These included use or human factor related issues (40%), software and hardware related issues (30%) and machine related issues (30%). Although many technical problems and deficiencies were detected in the reports identified, we did not anticipate that more than half of the incidents would have involved failures of human performance. Identifying and characterizing the things that are going wrong, related to HIT through thelens of medical imaging incident reports can provide a basis for preventing issues and improving clinical practice.

We reviewed initiatives to improve the quality and safety of health information technology in medical imaging through the lens of incident reports provided by healthcare professionals in each sequential step of the medical imaging process workflow. The 18 steps of imaging workflow were framed based on a literature review, visits to hospital radiology departments, interviews with radiologists, and iterative consultations with experts. Both inductive and deductive analyses were applied to 436 health information technology related incidents identified from 4,915 medical imaging incident reports. In the 18 imaging workflow steps both human (58%) and technical factors (42%) were involved. Classification from the perspective of the 18 steps of the imaging workflow was useful because it orientates the reporter and analysts to the tasks at each stage, and it also informs the analysts as to where corrective strategies could be addressed. Most of the things that go wrong in healthcare occur infrequently, so collecting information after they have gone wrong is the only practical approach to identifying and characterizing them. This should become a routine part of clinical practice in a complex constantly changing system.

Beyond identifying and counting the things that go wrong, understanding how and why they go wrong requires qualitative research, especially for low frequency events. The purpose of this study was to identify and characterize patient safety and quality issues related to health information technology (HIT) in medical imaging by collecting and analyzing incident reports through the lens of thematic analysis. In this article, we analyze 5 clusters: staff related issues (16%), issues withdiagnosis (15%), HIT incidents that involved “paperrecord” (12%), information and communication related(4%), and “action taken” related issues (4%). Human factors involved people failing to scan forms into the computer system (consents, requests, bookings,questionnaires, assessments, treatments andprescriptions), and another 4% involved failure to enter verbally imparted information into the system (aboutinfectious patients, cancelled cases, and the status ofreports). All of these problems had their genesis in human errors and violations. Human factors were found to cause more deleterious effects than technical factors. Of three instances of deaths caused by diagnostic issues, two were triggered by human factors, missed diagnosis. However, “staff or organizational outcome” was evenly distributed for both human and technical factors. It was therefore important to identify and characterize these incidents related to health information technology in medical imaging through the lens of thematic analysis, to providea basis for improvements in preventing issues and improving clinical practice.

Medical imaging health information technology systems, such as Radiology Information Systems and Picture Archiving and Communication Systems were introduced to improve efficiency. Although they have the potential to improve healthcare delivery and patient outcomes, when poorly designed, implemented or managed, they can pose substantial risks to patient safety and organizational efficiency, which may offset the intended benefits. This study used the method of thematic analysis, which provided information about system issues related to health information technology. System issues,including system error, system malfunction or failure, system design, system crash, system functionality, voice recognition technology, launching of new systems, and system integration accounted for 21% of the 436 HIT incidents. Even when these issues do not harm patients, they often cause delays, inconvenience, and inefficiencies. Obtaining the right system, proper and careful system implementation, and immediate back-up systems can improve the safety and quality of care in medical imaging.

The objective of this review is to find the best available evidence regarding effectiveness of quality improvement interventions in clinical radiology and the experiences and perspectives of staff and patients. More specifically, the review questions are: How effective are the interventions that may improve or affect patient safety and quality in clinical radiology? What are the experiences and perspectives of staff and patients of patient safety and quality improvement interventions?