Assessing STAMP EMR with Electronic Medical Record Related Incident Reports: Case Study: Manufacturer and User Facility Device Experience Database

At the turn of the millennium the institute of medicine (IOM) discovered that medical error was responsible for the deaths of as many as 98000 Americans each year. In response to this discovery they recommended the implementation of a wide range of Health Information and Communication Technology (HICT) including electronic medical records (EMRs). In spite of the broad based adherence of practitioners to these recommendation, the Agency for Healthcare Research and Quality (AHRQ) has not only failed to observe an improvement in the rate of errors, they have in fact observed the opposite. We propose that this failing arises from a fundamental misunderstanding of error which may be remedied by the application of a system theoretic framework. We propose a previously evaluated system model developed using the principles of the System Theoretic Accidents Models and Process (STAMP) framework for this purpose. In this work we aim to further assess the value of our model, STAMP EMR, by investigating the degree to which it aligns with the hazards and accidents reported in incident reports. We perform an initial coding of a corpus of incident reports against STAMP EMR as an a priori model. We analyze the raw results and further provide a multiple coordination analysis (MCA). We find firstly that no reports in the MAUDE could not be coded using the STAMP EMR model. We find secondly that four primary clusters of contributing factors are represented for the reports - validation, verification, engineering management and clinical management issues.