1. „Journal club“:
Vorstellung des Perspective Paper
The dangerous decade
Barcamp Health IT 2.0
03.April 2014, Berlin

2. 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

3. www.health20berlin.com
Twitter: @health20berlin

4. (Über-)Leben im gefährlichen Jahrzehnt:
The dangerous decade

5. 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

6. Der Autor
Enrico Coiera
Professor @ University of New South Wales, AUS
Director @ Center for Health Informatics
Australian Institute for Health Innovation
Twitter:@ EnricoCoiera

7. 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.

8. Kernthesen
Systems will be larger in scope,
more complex, and move from
regional to national and
supranational scale.

9. The paradox between ICT
and patient safety
ICT can improve the quality,
safety and effectiveness of clinical
services and patient outcomes.

10. Beispiel:
Handschriftliches Rezept
vs.
Elektronische Verordung
->Eindeutige Verordnung

11. 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.

12. 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.

13. Beispiel:
Problem: „Verutschen“ im Dropdown-Menue
(aus mg wurde g = 1.000-fache Dosis)
Eskalation 1: Bestätigungs-Popup
Problem: „Popups nerven“
Eskalation 2: Abgleich mit pharmakologischen
Datenbanken und Fehlermeldung bei „Falschdosierung“
Problem: Off Label Use (zum Beispiel Intensiv, Kinder)
Eskalation3: Personalisierte Alarmshemata
Problem:...
usw.

14. „Eskalationskaskade“
●
Eskalationsschritte nicht
einheitlich (Fehlende Standards)
●
Können auch ganz fehlen (z.B.
Mobile Apps)

15. Kernthesen
Even if ICT harm rates do not
increase, increased ICT use will
increase the absolute number of
ICT related harms.

16. 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

17. 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.

18. Kernthesen
Yet we are at roughly the same
place the aviation industry was in
the 1950s with respect to system
safety.

19. Kernthesen
Will health ICT have to go through
a similar painful period of learning
from unexpected accidents?

20. Fiktive Schlagzeilen
Patient starb durch Mobile App
Spiegleinonline, 1.April 20XX
Killer-App hat zugeschlagen
Blöd online, 1April 20XX

21. 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.

22. 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.

23. Fazit
Flugzeuge werden immer vom
Himmel fallen.
100%-ige Sicherheit wird es nie
geben.

24. 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

25. Vielen Dank!
Mit den besten Wünschen für
das Jahrzent!
Tobias Neisecke
tobias@health20berlin.com
Twitter @tobias_neisecke
www.medizin-und-neue-medien.de
Barcamp Health IT 2.0
03.April 2014, Berlin