We define the HIT work system as the combination of the hardware and software required to implement the HIT, as well as the social environment in which it is implemented. We thus propose that HIT errors should be defined from the socio-technical viewpoint of end users (including patients, when applicable) rather than from the purely technical viewpoint of manufacturers, developers, vendors, and personnel responsible for implementation. Health information technology related error occurs anytime the HIT system is unavailable for use, malfunctions during use, is used incorrectly, or when HIT interacts with another system component incorrectly resulting in data being lost or incorrectly entered, displayed, or transmitted.9,10
Errors with HIT may involve failures of either structures or processes and can occur in the design and development, implementation and use, or evaluation and optimization phases of the HIT life cycle.11
This approach is consistent with the currently recommended systems and human factors approaches used to understand and reduce error.1
The HIT system is considered to be unavailable
for use if for any reason the user cannot enter, review, transmit, or print data (e.g., patient’s medication allergies or most recent laboratory test results). Reasons could include unavailable computer hardware (e.g., missing keyboard or problems with the computer’s monitor, network routers that connect the computer to the data servers and printers, or the server where data is stored), unavailable software (e.g., missing components with the operating system that manages either the computer applications such as the internet browser and EHR or the interface between an EHR system and the information system of an ancillary service such as radiology or lab), and power sources (e.g., a power outage that results in hospital-wide computer failure).4
The HIT system is considered to be malfunctioning (i.e., available, but not working correctly) whenever a user cannot accomplish the desired task despite using the HIT system as designed. In this situation, error results from any hardware or software defect (or bug) that prohibits a user from entering or reviewing data, or any defect that causes the data to be entered, displayed, transmitted, or stored incorrectly. For example, the clinician might enter a patient’s weight in pounds, and the weight-based dosing algorithm might fail to convert it to kilograms before calculating the appropriate dose, resulting in a 2-fold overdose.
Finally, errors can occur even when hardware and software are functioning as designed. For instance, errors may result when users do not use the hardware or software as intended. For example, users might enter free-text comments (e.g., “take 7.5 mg Mon-Fri only”) that contradict information contained in the structured section of the medication order (e.g., “Warfarin tabs 10mg QD”).12
Errors may also arise when 2 or more parts of the HIT system (e.g., CPOE application and the pharmacy’s medication dispensing system) interact in an unpredicted manner, resulting in inaccurate, incomplete, or lost data during entry, display, transmission, or storage.13