2019 Fiscal Year Research-status Report
Patient safety: Casting a spotlight on electronic medical record-related incidents
| Project/Area Number |
19K15236
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| Research Institution | Tokyo Institute of Technology |
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Principal Investigator |
顧 秀珠 東京工業大学, 工学院, 准教授 (20632615)
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| Project Period (FY) |
2019-04-01 – 2022-03-31
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| Keywords | Patient safety / Incident / EMR system / Taxonomy |
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| Outline of Annual Research Achievements |
One of the achievements is a taxonomy system for electronic medical record (EMR)-related incident analysis. A literature survey and interviews to several healthcare professionals was conducted first to collect relevant information related to this research project. The information includes all the possible EMR-related failure types, contributing factors, outcomes, measures, etc. Then, more information of latent factors was obtained by semi-structured interviews with a number of healthcare staff about their self-experienced EMR-related critical incidents. In addition, using focus group discussions, a comprehensive picture of EMR-related safety problems was drawn. Based on all the investigated outcomes, an error taxonomy system specifically for EMR-related incidents was developed.
In addition, as EMR-integrated patient handoff system has been widely used in Japanese hospitals, effectiveness and risks of its adoption was observed that this approach had a limited effect on handoff performance. In some Japanese hospitals, against the background of widespread electronic system usage, the “silent report” method in handoff has received more attention recently as a cost-saving method. Thus, a mixed approach (verbal, written, technological) is suggested for patient handoffs, i.e., verbal handoff with a written summary generated by the electronic system.
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| Current Status of Research Progress |
Current Status of Research Progress
2: Research has progressed on the whole more than it was originally planned.
Reason
The progress of the project is almost as planned. For instance, the planned literature review and interviews to healthcare professionals were conducted to obtain information of all the possible EMR-related failure types, contributing factors, outcomes, measures, etc. Then, the planned semi-structured interviews with healthcare staff about their self-experienced EMR-related critical incidents were also conducted to obtain more information of latent factors. In addition, the planned focus group discussions participated by risk managers and those selected from interviewed were conducted as well. Therefore, a comprehensive picture of EMR-related safety problems has been drawn. Based on all the investigated outcomes, an error taxonomy system specifically for EMR-related incidents was developed as planned in FY2019. In addition, problems of EMR-integrated patient handoff system were explored that was not included in the plan but useful results were obtained.
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| Strategy for Future Research Activity |
There are several steps for the following research:
(1) To collect various EMR-related incident data: EMR-related incident and accident records will be collected from a number of hospitals. In addition, to collect more information of errors related to EMR systems, observations are planned to be performed.
(2) To capture EMR-related incident characteristics: Applying the developed taxonomy system to all the incidents and accidents collected from interviews, hospital records and observations as mentioned above, characteristics of EMR-related incidents in the current context of Japanese hospitals will be explored. To confirm the results obtained from taxonomy analysis, a questionnaire survey will be conducted to healthcare staff about their perspectives of EMR-related incidents such as frequency and severity of each type of errors, and latent factors contributing to these errors.
(3) Todevelop an EMR-related incident management system: EMR-related patient safety management experience will be learned from EMR advanced countries. Cooperation could be obtained from researchers in Norway and Denmark. Based on all the results obtained, an EMR-related incident management system will be developed.
(4) To implement the EMR-related incident management system and validate its effectiveness.
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| Causes of Carryover |
As observations will be conducted to healthcare professionals, video cameras are needed. In addition, computer-related consumables such as paper and toners of printer are also needed. Accordingly, costs for these expendables are put in the budget. As information and records will be obtained from hospitals, the applicant should make domestic travels. Thus, expenses of domestic travels are included. In addition, to those who cooperated in providing information, remunerations are needed for their contributions. Then, a graduate student is required assisting in questionnaire survey, data analysis, observations and preparation of reports. Thus, costs are needed for RA remunerations. In addition, for the survey, costs for questionnaire copies and post are necessary. To disseminate the results to the society and to gain experience and advice from international researchers, attending international conferences and making research discussions with foreign scholars are crucial. Therefore, oversea travel expenses as well as registration fees of the international conferences are included in the budget plan.
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