Identifying common problems in the acquisition and deployment of large-scale, safety–critical, software projects in the US and UK healthcare systems

Public and private organisations are investing increasing amounts into the development of healthcare software. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardized procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the safety concerns that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail of electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of healthcare information systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems.

Research highlights
► This paper identifies safety-related risks in Healthcare Information Technology; HIT.
► Staff must resort to unfamiliar fall-back paper records when electronic systems fail.
► Treatments are based on partial information or delayed until systems are restored.
► These hazards are illustrated by a comparison of recent failures in UK and US HIT.
► We conclude there is an urgent need to improve information exchange on HIT failures.