Information and Knowledge Management using ArcGIS ModelBuilder

Mohamad Norzamani Sahroni and Maryati Mohd Yusof
2.1.1 Error reduced by HIS
There were number of quantitative studies that described the realization of HIS in reducing errors.
Anderson (1997) from his simulation found that number of adverse drug event and length of hospital
stay reduced up to 25 percent using Clinical Information Systems (CIS) compared to manual systems.
Meanwhile Bates et al. (1998), from their before-and-after comparison study proved that more than 50
percent error reduction in all medication processes after the introduction of Computerized Physician
Order Entry (CPOE) in actual setting of two large tertiary hospitals. A number of other studies also
establish the success of HIS in reducing medical errors such (Larum et al. 2001, Hersh 2002, Chung
et al. 2003, Dobson 2003, Potts et al. 2004, Kenagy 2007, Van Doormaal et al. 2009, Poon et al.
2010). A systematic reviewed paper by Kaushal et al. (2003) and quasi experimental studied by Poon
(2010) best concluded that the use of HIS significantly reduce medical error rates if not to eliminate all
(Dror 2010).
2.1.2 Error nurtured by HIS
Whilst HIS is a tool to increase patient safety and to reduce medical error in healthcare, other studies
revealed undesirable outcome following to HIS adoption. It is due to reason that HIS will consistently
introduce new mistakes and new harm every time its adapt with new workflow and environment
because of a new or enhanced system took place (Ash et al. 2004, Campbell et al. 2006). Various
studies have been reported that HIS produce unintended adverse consequences (Bell et al. 2004,
Ash et al. 2009, Patel and Kane-Gill 2010) after its adoption. Ash et al. (2004) in their qualitative study
found that the implementation of a Patient Care Information Systems (PCIS) could actually trigger
new errors that emerge from the process of entering and retrieving information, and those in the
communication and coordination process. Later Ash et al. (2007) and (2009) in their mixed method
study, categorized new kind of errors such as juxtaposition errors as one of the eight and the nine
types of undesirable consequences. Campbell (2006) also reported the same finding of this
undesirable outcome in HIS. Zhang (2004) and Sun et al. (2008) theoretically proposed different
cognitive errors on individuals interactions with HIS. Borycki and Kushniruk (2005) through their
simulation discovered more medical errors related to usability problem. Meanwhile, Ammenwerth and
Shaw (2005) provide a list of typical systems error emerge in HIS such as functional error and
systems crash that affect the health care processes and harm patient. Further, Koppel (2008) added
various possible errors such as wrong medication and dose could emerge from the implementation of
Barcoded Medication Administration (BCMA) systems. These scenario gives impression that “errors
can be prevented by designing systems that make it hard for people to do the wrong thing and easy
for people to do the right thing” (Kohn et al. 2000) is still questionable.
2.2 The need of evaluation
The evidences of error are symptoms of flawed systems (Newton et al. 2010) and that is inadequate
fit the to multifaceted health care processes (Hübner-Bloder and Ammenwerth 2009, Ammenwerth et
al. 2010a). Garfield (2009) and (Vozikis 2009) explained that many related studies were carried out in
individual medication stages rather than the whole medication process that lead to difficulties to
identify the cause of error occurrence and its impact on another medication stages. As an example,
error in dispensing stage could be avoided if error in prescribing stage first identified (Valentin et al.
2009, Van Doormaal et al. 2009). However, study by Garfield et al. (2009) has its limitation which lack
to provide the dearth of medication process that teething problem to recognize the root cause of error.
Thus evaluation in health care cannot be performed from a single and linear perspective rather need
thorough analysis because of its complexity (Patel and Kane-Gill 2010).
3. Highlight of issues
Based on research background in section 2, this study is intended to highlight three issues related to
error in HIS that further elaborates in the following sub-sections.
3.1 The extent of HIS reduces and nurtures error
Despite the latter success of HIS in reducing medical error (Poon et al. 2010), the claim is subtle
(Anderson 1997, Kenagy 2007) and has not been demonstrated clearly (Koppel et al. 2005, Koppel et
al. 2008, Ammenwerth et al. 2010b) especially related on the use of common terminology and
reporting such as type of error that cannot be resolved even after HIS implementation. Study by
Koppel et al. (2005) is the example of work that reports explicitly on type of error occurred but limited
to error on medication process as most other studies reported. The ambiguity of medical error may be