IS E-HEALTHCARE CHART CONTRIBUTORY TO PATIENT

SAFETY?

Kiyomu Ishikawa, Takeshi Tanaka, Minoru Ikeuchi and Hidehiko Tsukuma

Department of Healthcare Informatics and Hospital Systems Management,

Hiroshima University Hospital, Hiroshima, Japan

Keywords: E-Healthcare Chart, Questionnaire Survey, Medical safety, Provision of training opportunities.

Abstract: Toward 503 hospitals evaluated by Japan Council Health Care (JCHC), the questionnaire survey was

conducted and analysed according to 2 groups of pre-2005 and post-2006 system introduction. As the result,

it was found that despite with the annual improvement in the e-healthcare chart system function, both

information system and users’ operation were insufficient with concern of medical accidents: About sixty

per cent of the hospitals have experienced information-system-related harmful incidents. Among the

hospitals that implemented information security education of health information system, 60% had triggered

harmful incidents, and preavoid experience. In contrast, 40% of hospitals without information security

education had triggering experience. We found preavoid experiences in 70% of those reported no preavoid

experiences. There is a possibility that the organizational development for information literacy raises the

consciousness of users towards harmful incidents through the accumulation of information on such

incidents.

1 AIM

E-healthcare Chart or EHR has been developed as

the key medium to support individual lives by

means of multi-occupational networking. Today, it

could be the core tool in team healthcare process.

While, according to the survey of 273 public and

national hospitals (together 144,019 beds) from

January to June, 2009, 172 facilities reported fatal

medical accidents (JCQHC). Here, based on “The

survey of the development and issues on the

computerization of medical process” of the hospitals

included in the study, the experience rates of

harmful incidents are compared with the provision

of training opportunities.

2 METHOD

The internet-based questionnaire survey was

conducted from July to August, 2009, and 1488

target hospitals which had been authorized to meet

the functional criteria by Japan Council for Quality

Health Care (JCQHC) were asked to fill in the forms

with both multiple choice and open questions.

The focus was “the relation between the

occurrence of harmful incidents or prevention

experience, management organization and training

system.”

The following topics were analyzed.

a. The introduction status of a health care

information system

b. The status of the education of the hospital

personnel for the use of the healthcare

information system

c. Is healthcare chart monitored to check the

risk of harmful incidents?

In Japan, the Ministry of Health, Labor and

Welfare enacted “the guidelines for safety

management of health information systems” (Japan

Ministry of Health, Labour and Welfare in 2005. In

order to find the effects of the guideline

enforcement, the target hospitals were classified into

2 groups, one that included hospitals with systems

introduced before 2005, and the other with hospitals

that introduced the system later.

3 RESULT

3.1 The Introduction Status of Heath

Information System

Answers were received from 503 hospitals (33.8%).

430

Ishikawa K., Tanaka T., Ikeuchi M. and Tsukuma H..

IS E-HEALTHCARE CHART CONTRIBUTORY TO PATIENT SAFETY?.

DOI: 10.5220/0003846904300433

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2012), pages 430-433

ISBN: 978-989-8425-88-1

 2012 SCITEPRESS (Science and Technology Publications, Lda.)

Figure 1: The confirmation function ordering receipt.

The larger scale hospitals showed the highest

answering rate. Focusing on the occupation of

answerers, clerks are listed at the top, followed by

nurses, system engineers of information

management department of hospitals.

This survey shows that above 90% hospitals

introduced health information systems. Among them

187 hospitals (41%) which introduced health

information system after 2006. Looking at the

introduction rates in relation to the size of the

hospitals we found that hospitals with over 201 beds

actively progress the computerization of an ordering

system.

Furthermore, focusing on the medical care

process from physicians’ ordering to the

confirmation of nurses’ practice after order

receiving, the systems of the post-2006 hospitals

have more advanced checking function than pre-

2005 hospitals (Fig 1).

3.2 The Relation to Harmful Incident

Among the hospitals that implemented information

security education of health information system,

59.6% (242/406) had triggered harmful incidents

and 38.4% (153/406) had not, and 61.3% (249/406)

had preavoid experiences and 38.7% (157/406) had

not.

In contrast, 38.1% (37/97) of hospitals without

information security education had triggering

experience, and 54.6% (53/71) had not. We found

preavoid experiences in 33.0% (32/97) of the

hospitals, and 67.0% of those hospitals reported no

preavoid experiences (65/97). (Fig. 2)

3.3 The Cause of Harmful Incident

The system-based harmful incidents were caused by

users operation or program imperfection rather than

system troubles such as “Input of wrong

information” (71.7%; 200/279), “No input of

necessary information” (29.4% (82/279) in the

system without warning function and 25.8%

(72/279) in disregard of warning function), and

“Impossible input due to master registration or

master maintenance imperfection” (22.9%; 64/279).

(Fig 3)

On the other hand, the cases of preavoid harmful

incidents by system operation are listed as “Patient

misconception” (68.3%; 192/281), “Dosing wrong

medicine” (56.6%; 159/281) or “Ordering of wrong

procedure or test” (31.3%; 88/281). “The prevented

Cases of Patient Misconception” are somewhat

higher in the post-2006 group.

23.0%

35.3%

27.1%

33.2%

22.8%

20.6%

13.6% 4.9%

1.2%

8.7%

6.5%

3.2%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

Before 2005

After 2006

Confirmation of "Ordering receipt"

Confirmation the stage from "Odering receipt" to "Pre-performance"

Confirmation of "Done"

Unable to Confirm

The others

ＮＡ

391

340

IS E-HEALTHCARE CHART CONTRIBUTORY TO PATIENT SAFETY?

431

Figure 2: Relations between education and experiences of harmful incidents.

4 DISCUSSION

4.1 The Occurrence / Prevention of

Harmful Incident and Staff

Education

When the survey results mentioned from 3.1 to 3.3

are compared with the past case (Ishikawa et al.,

2007), (though the answering hospitals and

answerers were different), it is supposed that e-

Healthcare chart has become well-established as the

standard tool in the Japanese hospitals. Especially,

due to the progress of “checking function of medical

process”, it will shortly meet the functional

requirements as information infrastructure for use

inside the hospital. It is also supposed that the

system with the Bar-code-used matching function

between patients and medical practice became more

popular. Nevertheless, the present survey did not

provide the definite evidence that the functional

improvement has contributed to prevention of

harmful incidents.

As shown in Sec. 3.2 (Fig 2), there is a

possibility that the organizational development for

information literacy raises the consciousness of

users towards harmful incidents through the

accumulation of information on such incidents.

4.2 The Occurrence / Prevention of

Harmful Incident and Staff

Education

According to 3.3 (Fig 3), the causes of human issues

are mainly input error related causes and master

troubles. In order to settle these issues, from the

view point of another questionnaire survey by

JCQHC (JCQHC, 2009), it is crucial to classify

cases into “(1) Careless mistakes” and “(2) Common

and organizational issues”. Furthermore, the cases of

“Careless mistakes” need to be examined whether

there are possibilities of improvement by means of

warning in case of wrong input of names, quantity,

and item selection or pick up of mandatory input

items and warning to check mandatory input.

Under the on-going rapid computerization, the

partnership building between vendors and users will

be the key for designing the practical measures

based on the integrated examination outcomes of

multiple hospitals and rapidly implementing the

measures identified in the software.

Through this study, it was found that harmful

incidents do not always result from information

system-based hardware or software troubles. They

are related with the human factors included in the

medical process.

59.6%

38.1%

38.4%

54.6%

0% 20% 40% 60% 80% 100%

Hospitals with

security education

Hospitals without

security education

Harmful Incidents was triggered Harmful Incidents was not experienced Others

N=406

N=97

61.3%

33.0%

38.7%

67.0%

0% 20% 40% 60% 80% 100%

Hospitals with

security education

Hospitals without

security education

Experience of preavoid No experience of preavoid

N=406

N=97

HEALTHINF 2012 - International Conference on Health Informatics

432

Figure 3: The Causes of Information System-Related Harmful Incidents.

5 CONCLUSIONS

The aim of the e-Healthcare Chart system

introduction has changed for this decade, and at

present the aim is not achieved completely. Three

principles of preservation by e-media including e-

healthcare chart were “Accountability”,

“Availability”, and “Storage ability” based on eight

principles of the OECD Board of Directors. It means

that in order to assure “patient safety”, the medical

quality should be improved by interactive

confirmation of medical process from ordering to

practice among multi-occupational sites. However,

despite the diverse requirements of system functions,

they are hardly achieved at present. For this aim, the

specialized usage of patient data and system

designing along with medical performance should be

prioritized.

ACKNOWLEDGEMENTS

This work was supported by the Grant-in-Aid for

Scientific Research (A) No. 21249035 of the

Ministry of Education, Culture, Sports, Science and

Technology, Japan.

REFERENCES

JCQHC, The 18

Report on the Medical Accident

Collection Project of JCQHC: http://www.med-safe.

jp/pdf/report_18.pdf

Japan Ministry of Health, Labour and Welfare, The

guideline on a safety management of medical informa-

tion system (the 1

edition): http://www.mhlw.go.jp/

shingi/2005/03/s0331-8.html

K. Ishikawa et al. “The Guideline of the Personal Health

Data Structure to Secure Safety Healthcare –The

balance between use and protection to satisfy the

patients’ needs-: Int. J. of Med. Info. Vol. 76 No. 5-6,

pp. 412-418 (2007).

JCQHC, For Making the case collection book: The

meeting material for the 3

review meeting on

computerized information devices in 2009 (2009).

71.7%

33.7%

29.4%

25.8%

22.9%

15.4%

12.9%

10.0%

6.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0%

* Input of Wrong Information

Networking Trouble

* No Input of Mandatory Information

(Without Warning Function)

* No Input of Mandatory Information

(With Warning Function)

* Unable to Input (Imperfection of Master

Registration and Maintenance)

Unable to Input (System Trouble)

No Image Output (Designing Imperfection)

No Image of Mandatory Information

Others

* Human Causes

N-279

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