Software-related challenges in Swedish healthcare through the lens of incident reports: A desktop study.

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.

Assessing the healthcare quality issues for digital incident reporting in Sweden: Incident reports analysis.

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

Issues with the Swedish e-prescribing system - An analysis of health information technology-related incident reports using an existing classification system.

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 sources using 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 Health Information 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 software systems or components, software functionality, data storage and backup, record migration, software not accessible, and network/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, implementation and use-related issues, and the problems related to monitoring, evaluation, and optimisation.

Characterizing healthcare incidents in Sweden related to health information technology affecting care management of multiple patients.

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.