The dangerous decade

Abstract

Over the next 10 years, more information and communication technology (ICT) will be deployed in the health system than in its entire previous history. Systems will be larger in scope, more complex, and move from regional to national and supranational scale. Yet we are at roughly the same place the aviation industry was in the 1950s with respect to system safety. Even if ICT harm rates do not increase, increased ICT use will increase the absolute number of ICT related harms. Factors that could diminish ICT harm include adoption of common standards, technology maturity, better system development, testing, implementation and end user training. Factors that will increase harm rates include complexity and heterogeneity of systems and their interfaces, rapid implementation and poor training of users. Mitigating these harms will not be easy, as organizational inertia is likely to generate a hysteresis-like lag, where the paths to increase and decrease harm are not identical.

Figure 1

ICT-associated patient harm is likely to increase in step with ICT usage. Different system configurations will have higher or lower opportunities for harm within them, shaping the actual harm rate experienced. ICT, information and communication technology.

Figure 2

Changes in configuration will alter the opportunities for harm within a system, some making it safer and others less so. Harm rates are likely to be higher with increased complexity, and truncated implementation times. These harms will reduce as technology, training and implementation practices mature. System inertia is likely to make this process path dependent, so that decreasing the opportunity for harm will exhibit hysteresis.