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„Journal club“:Vorstellung des Perspective Paper
The dangerous decade
Barcamp Health IT 2.0 03.April 2014, Berlin
About me
Tobias Neisecke
Approbierter Arzt & Examinierter Krankenpfleger
Wissenschaftl. Mitarbeiter Uni-Klinik
Entrepreneur im 3D Umfeld
Blogger – medizin-und-neue-medien.de
Co-Organizer Health 2.0 Berlin
www.health20berlin.comTwitter: @health20berlin
(Über-)Leben im gefährlichen Jahrzehnt:
The dangerous decade
Fakten
Titel: The dangerous decade
Autoren: Enrico Coiera, Jos Aarts, Casimir Kulikowski
Published: 24. November 2011 online
Journal of the American Medical informatics Association (JAMIA)J Am Med Inform Assoc 2012;19:2-5 doi:10.1136/amiajnl-2011-000674
Der Autor
Enrico Coiera
Professor @ University of New South Wales, AUS
Director @ Center for Health Informatics
Australian Institute for Health Innovation
Twitter:@ EnricoCoiera
Kernthesen
Over the next 10 years, more information and communication technology (ICT) will be deployed in the health system than in its entire previous history.
Kernthesen
Systems will be larger in scope, more complex, and move from regional to national and supranational scale.
The paradox between ICT and patient safety
ICT can improve the quality, safety and effectiveness of clinical services and patient outcomes.
Beispiel:
Handschriftliches Rezept
vs.Elektronische Verordung
->Eindeutige Verordnung
paradox between ICT and patient safety
->Rapid deployment of ICT is a priority for many nations faced with a diminishing clinical workforce, increasing workloads, and resource constraints.
paradox between ICT and patient safety
ICT use can also lead to patient harm. ICT has yet to deliver on its promises. The rapid adoption of ICT is a risk.
Beispiel:
Problem: „Verutschen“ im Dropdown-Menue (aus mg wurde g = 1.000-fache Dosis)
Eskalation 1: Bestätigungs-PopupProblem: „Popups nerven“
Eskalation 2: Abgleich mit pharmakologischen Datenbanken und Fehlermeldung bei „Falschdosierung“ Problem: Off Label Use (zum Beispiel Intensiv, Kinder)
Eskalation3: Personalisierte AlarmshemataProblem:...usw.
„Eskalationskaskade“
●Eskalationsschritte nicht einheitlich (Fehlende Standards)
●Können auch ganz fehlen (z.B. Mobile Apps)
Kernthesen
Even if ICT harm rates do not increase, increased ICT use will increase the absolute number of ICT related harms.
Non-linearer Anstieg?
● number of new implementations●number of new users●growth in rate of usage
contribute to increased harm, suggesting more of a logistic curve
19.02.14
ICT-associated patient harm is likely to increase in step with ICT usage.
Coiera E et al. J Am Med Inform Assoc 2012;19:2-5
Copyright © by the American Medical Informatics Association. All rights reserved.
Kernthesen
Yet we are at roughly the same place the aviation industry was in the 1950s with respect to system safety.
Kernthesen
Will health ICT have to go through a similar painful period of learning from unexpected accidents?
Fiktive Schlagzeilen
Patient starb durch Mobile AppSpiegleinonline, 1.April 20XX
Killer-App hat zugeschlagenBlöd online, 1April 20XX
19.02.14
Changes in configuration will alter the opportunities for harm within a system, some making it safer and others less so.
Coiera E et al. J Am Med Inform Assoc 2012;19:2-5
Copyright © by the American Medical Informatics Association. All rights reserved.
Soziotechnischer Kontext
Our understanding of the unintended opportunities for harm that arise when interruptions and multitasking disrupt clinicians using information systems is also in its infancy.
The psychological literature on interruption is complex, and designing ICT that is ‘interruption safe’ remains a challenging goal.
Fazit
Flugzeuge werden immer vom Himmel fallen.
100%-ige Sicherheit wird es nie geben.
Fazit
Entwicklung von sicherer ausgereifter Health IT bedeutet enormen Aufwand,
aber
● sichert (langfristigen) wirtschaftlichen Erfolg● Zeigt Verantwortung● Führt zu Akzeptanz beim Nutzer und der
Öffentlichkeit
Vielen Dank!Mit den besten Wünschen für
das Jahrzent!Tobias Neisecke
[email protected] @tobias_neisecke
www.medizin-und-neue-medien.de
Barcamp Health IT 2.0 03.April 2014, Berlin
