industry & reform
Data error
“ If we don ’ t pay attention to it , we can harm patients .
Healthcare digitisation leading to more data-induced harm .
By Elise Hartevelt
Professor Enrico Coiera says his prediction that digitisation in healthcare over the past decade would lead to increased data-driven patient harm has come true .
Ten years ago the director of the Centre for Health Informatics at Macquarie University warned in his paper ‘ The Dangerous Decade ’ that technology innovation needed to go hand in hand with safeguarding digital health .
“ Instead , we ’ ve seen a huge encroachment of digital health , especially in keeping electronic records around every level of healthcare delivery ,” he said .
Digital health involves using information and communication technology ( ICT ) in healthcare settings to improve patient wellbeing , such as telehealth and telemedicine .
Coiera foreshadowed that ICT deployed in healthcare over the past decade would amount to more than in the health system ’ s entire history .
While data-driven healthcare has rapidly improved how we receive care , he said the progress may compromise digital health .
“ For many organisations worldwide , digital health safety is now a significant issue .
“ If we don ’ t pay attention to it , we can harm patients .”
Data-related harm may result from human errors , wrong alerts and missing data within the system , or downtime where the network crashes or the power goes off .
Other events , such as the recent flooding in NSW and Queensland that impacted hospitals and GP practices , can also cause data breaches .
Coiera said that while digitisation is now everywhere – from patient record systems like Medicare and mail merges that deliver test results – there are harms and benefits .
“ Things go wrong for complicated reasons , but they do go wrong .”
OAIC ’ s annual report revealed that a fifth of all data breaches in the first half of 2021 occurred in the healthcare industry , leading OAIC to call it a ‘ cause for concern ’.
Similarly , the Notifiable Data Breaches scheme said the sector has recorded the highest number of compromised data incidents for nearly four years .
“ Digital risks continue to be one of the largest risks many healthcare companies have ,” Coiera said .
“ Negative outcomes have been rare , but we are now rolling out these systems on a scale that we ’ ve never seen before , and there is still a long list of things that can go wrong .”
He said digital safety in healthcare is a complex issue where people need to use ICT under high work pressure .
“ In the current Covid situation , people are also burned out and understaffed , so we know that when something goes wrong , it ’ s usually a chain of events that lead to the actual harm event or patient incident .”
Although innovative technology has been implemented in many healthcare settings , older operating systems can be very clunky and slow .
“ You might have a screen that ’ s not so easy to navigate , so you might have a very busy and distracted nurse , who incorrectly enters data into the wrong field , causing the wrong drug to be given .”
Lacking the appropriate staff , healthcare workers have found ways to bypass slow systems to work more efficiently .
“ I can give you a very famous one : when a nurse is administering medicine to patients in a ward , they ’ re meant to scan the barcode ,” Coiera said .
“ And so what nurses do to save time is to take all the barcodes and put them on their arm .
“ Of course , that breaks the safety mechanisms embedded in checking the patient in front of you .”
Yet , he also highlighted the need for more updated systems and staff training to smooth out the workflow .
While basic standards to operate ICT are being adopted in many healthcare settings , the workforce is still lacking user-friendly design and support .
“ Usually , the electronic record systems we get are tough to change once they ’ re in place , and often things we want to do just don ’ t necessarily fit in the very old systems ,” Coiera said .
“ We would love to see a more app-like world , where you can create specific tools in the system to assist different tasks , and they would be like apps and connect to an electronic record .
“ Although this is being implemented in some areas , historically , innovation has been difficult because of the control the companies have had on design .”
Coiera said that in the end , every clinician should put patient safety as the priority in all they do , whether they ’ re busy or not .
“ Every time we bring in a workaround or a shortcut because we are busy , short staffed or under pressure , we just have to be aware that that ’ s not a risk-free decision .” ■ nursingreview . com . au | 11