Information and Knowledge Management using ArcGIS ModelBuilder

Evaluation of Error Management in Health Information
Systems: A Review
Mohamad Norzamani Sahroni 1, 2 and Maryati Mohd Yusof 1
1
National University of Malaysia (Universiti Kebangsaan Malaysia), Bangi,
Malaysia
2
Universiti Teknologi MARA, Shah Alam, Malaysia
zamani@tmsk.uitm.edu.my
mmy@ftsm.ukm.my
Abstract: In a complex environment such as health care, the occurrence of error is inevitable but it is preventable
with early pre-emptive action. This paper discusses the evaluation of errors related to pre and post Health
Information Systems (HIS) adoption in health care. Various studies in medical informatics show concern on errors
in health care delivery and advocate the use of HIS as a means to reduce the error. In general, the evaluation of
medical error in health care can be viewed from two states of circumstances. The first state is related to error that
occurs prior to HIS adoption and the second state corresponds to error identified after HIS implementation.
However, the extent of error reduction that can be associated to HIS implementation is subtle. Instead, the use of
HIS has unintended consequences that fosters new error. Thus, it is important to evaluate how HIS outcome
reduced existing error or nurtures new one in clinical process. With regards to the outcome, this research also to
seek identify factor that contributes to medical error. Overall, literature in medical error highlight human as the
major contributing factor to error, apart from technological and organizational factors. However, individual is just a
part of a multifaceted health care environment; therefore, it is relevant to investigate other factors that relate or
cause the human error, such as the complexity of organizational process. We also aim to identify potential
intervention that can prevent error from re-occurring. Currently, there are a number of guidelines and frameworks
that focus on medical error. Each of these frameworks has its own strength and limitation according to its context
towards patient safety. Therefore, our research aims to propose a comprehensive framework on error
management in HIS that could inform decision making to assess and mitigate errors prior and subsequent to HIS
implementation.
Keywords: evaluation, error, health information systems, review
1. Introduction
Studies in medical informatics show concern on errors in health care delivery. Medical error in our
research context is referred to as “an injury caused by medical management rather than the
underlying condition of patient’ which is contributed to big proportion of adverse event in health care
(Kohn et al. 2000). Therefore, Health Information Systems (HIS) is advocated to reduce medical error
as well as to provide better decision making for patient safety and cost effective measures. However,
the recent study by (Liu et al. 2011) described that the adoption of HIS remains comparatively slow
due to usability and cultural barriers. Earlier, Zapf (1992) usability as type of error associates with
computers and particularly with HIS (Borycki and Kushniruk 2005). It shows that while HIS aims to
reduce medical error, it also nurtures new one. The occurrence of error shows that patient health
might be threatened by the failure of health care systems and to certain extent it can be fatal (Han et
al. 2005).
Error occurred in complex environment such as health care is inevitable. However, error is
preventable if early pre-emptive action is deployed. The following section discusses the occurrence of
error in HIS. Section 3 reviews and highlights issues associated to error in HIS. Finally, a conclusion
and future work discussed in section 4 on proposing error management model in HIS.
2. Medical error in HIS
Error in health care can be viewed from two states of circumstances; before and after HIS adoption.
Prior HIS adoption, the former error occurred in numerous occasions are; during diagnosis due to
incomplete patient history, in prescription such as miscalculation of drug dosage and frequency, and
in transcribing doctor’s handwritten prescriptions that lead to dispensing wrong drugs to the patient.
Errors occurred in these medical processes can be reduced by implementing HIS such as Computer
Provider Order Entry (CPOE) (Kohn et al. 2000) for better decision making and patient safety.
The latter outcome of HIS associated with error after its adoption can be viewed from two
perspectives; the success of HIS in reducing error and generating new error subsequent to its
adoption as discusses in section 2.1.1 and 2.1.2.