barcamp health it berlin2014 tobias neisecke-final

„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

tobias@health20berlin.comTwitter @tobias_neisecke

www.medizin-und-neue-medien.de

Barcamp Health IT 2.0 03.April 2014, Berlin