Ensuring Patient Safety through Digital Health Technologies

Abstract

Patient safety is a core objective in healthcare, aiming to minimize risks, prevent avoidable harm, reduce errors, and mitigate the impact of adverse events. While some errors are easily identifiable, others require retrospective analysis to determine their consequences for specific patient groups. Patient safety is often discussed alongside quality of care, as both involve reducing harm and improving healthcare outcomes. Beyond being a fundamental goal, patient safety is a discipline that applies safety science to healthcare delivery. Safety science integrates engineering, psychology, human factors, risk management, and organizational behavior to improve systems, technologies, and human behavior, ultimately enhancing safety and reducing hazards. This thesis explores how digital health technologies can enhance patient safety, focusing on the National Hospital of Iceland’s digital health platform. The platform includes web and mobile applications for healthcare professionals and patients, integrating third-party solutions to modernize healthcare, streamline workflows, and improve access to patient data. A co-design approach involving healthcare professionals and patients has been used in its development, ensuring user needs are addressed. The effectiveness of medical treatments relies heavily on human behavior. The decision-making of both healthcare professionals and patients can be influenced by their environments, and even minor changes in how information is presented can significantly affect these user groups’ behavior. The concept, known as “choice architecture,” includes the use of “nudges” to guide decisions without restricting options. In healthcare, framing user interface design choices, such as physician recommendations for vaccines or default settings in electronic health records for prescriptions, can greatly impact treatment choices. As healthcare becomes increasingly digital, digital nudging offers a valuable tool for improving patient safety. This thesis examines digital nudging from the perspective of digital health platform designers working closely with healthcare professionals. While prior research has highlighted how digital nudges benefit patient care, there is limited exploration of how these nudges are designed and developed to enhance patient safety. The research is based on five papers that analyze different aspects of digital health technologies. Paper P1 investigates how the introduction of a mobile app for bedside documentation supports patient safety. Paper P2 examines how data collection through digital tools can improve quality of care, particularly for patients with atrial fibrillation before and after surgery. Paper P3 shifts focus to patients with inflammatory bowel diseases, exploring how a digital health program influences health outcomes and literacy. Paper P4 systematically reviews digital nudges in healthcare, assessing their impact on treatment and patient management. Paper P5 explores user perceptions of digital nudges and develops design guidelines for their ethical implementation. To study the various aspects of digital health technologies incorporated into the National Hospital digital health platform and how they contribute to patient safety we adopt both qualitative and quantitative methods. For our research design, we have strategized to use empirical data from the National Hospital to answer the research question. We apply standard usability questionnaires to measure the views of the healthcare professionals, and to measure the impacts of the design features we compare usage of the healthcare professionals before and after the features were deployed. The thesis (i) examines five themes that can contribute to the design and development of DHTs that ensure patient safety (ii) presents six dimensions that can contribute to patient safety in the design of DHTs, and (iii) presents a model that conceptualizes socio-technical key elements of patient safety. Together, the findings contribute to the discourse of digital health platforms in the information system literature with the conceptualization of the examination of a continuous co-design process.Patient safety is a core objective in healthcare, aiming to minimize risks, prevent avoidable harm, reduce errors, and mitigate the impact of adverse events. While some errors are easily identifiable, others require retrospective analysis to determine their consequences for specific patient groups. Patient safety is often discussed alongside quality of care, as both involve reducing harm and improving healthcare outcomes. Beyond being a fundamental goal, patient safety is a discipline that applies safety science to healthcare delivery. Safety science integrates engineering, psychology, human factors, risk management, and organizational behavior to improve systems, technologies, and human behavior, ultimately enhancing safety and reducing hazards. This thesis explores how digital health technologies can enhance patient safety, focusing on the National Hospital of Iceland’s digital health platform. The platform includes web and mobile applications for healthcare professionals and patients, integrating third-party solutions to modernize healthcare, streamline workflows, and improve access to patient data. A co-design approach involving healthcare professionals and patients has been used in its development, ensuring user needs are addressed. The effectiveness of medical treatments relies heavily on human behavior. The decision-making of both healthcare professionals and patients can be influenced by their environments, and even minor changes in how information is presented can significantly affect these user groups’ behavior. The concept, known as “choice architecture,” includes the use of “nudges” to guide decisions without restricting options. In healthcare, framing user interface design choices, such as physician recommendations for vaccines or default settings in electronic health records for prescriptions, can greatly impact treatment choices. As healthcare becomes increasingly digital, digital nudging offers a valuable tool for improving patient safety. This thesis examines digital nudging from the perspective of digital health platform designers working closely with healthcare professionals. While prior research has highlighted how digital nudges benefit patient care, there is limited exploration of how these nudges are designed and developed to enhance patient safety. The research is based on five papers that analyze different aspects of digital health technologies. Paper P1 investigates how the introduction of a mobile app for bedside documentation supports patient safety. Paper P2 examines how data collection through digital tools can improve quality of care, particularly for patients with atrial fibrillation before and after surgery. Paper P3 shifts focus to patients with inflammatory bowel diseases, exploring how a digital health program influences health outcomes and literacy. Paper P4 systematically reviews digital nudges in healthcare, assessing their impact on treatment and patient management. Paper P5 explores user perceptions of digital nudges and develops design guidelines for their ethical implementation. To study the various aspects of digital health technologies incorporated into the National Hospital digital health platform and how they contribute to patient safety we adopt both qualitative and quantitative methods. For our research design, we have strategized to use empirical data from the National Hospital to answer the research question. We apply standard usability questionnaires to measure the views of the healthcare professionals, and to measure the impacts of the design features we compare usage of the healthcare professionals before and after the features were deployed. The thesis (i) examines five themes that can contribute to the design and development of DHTs that ensure patient safety (ii) presents six dimensions that can contribute to patient safety in the design of DHTs, and (iii) presents a model that conceptualizes socio-technical key elements of patient safety. Together, the findings contribute to the discourse of digital health platforms in the information system literature with the conceptualization of the examination of a continuous co-design process.