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High quality, safe healthcare = technology + people + systems thinking
  1. David Greenfield1,
  2. Usman Iqbal2,3 and
  3. Yu-Chuan (Jack) Li4,5,6
  1. 1School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, New South Wales, Australia
  2. 2Global Health and Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
  3. 3Health ICT, Department of Health, Hobart, Tasmania, Australia
  4. 4Graduate Institute of Biomedical Informatics, College of Medical Science & Technology, Taipei Medical University, Taipei, Taiwan
  5. 5Dermatology Department, Wan-Fang Hospital, Taipei, Taiwan
  6. 6International Association of Medical Informatics (IMIA), Geneva, Switzerland
  1. Correspondence to Professor Yu-Chuan (Jack) Li; jack{at}

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The BMJ Health & Care Informatics presented two editors’ choice papers examining two different, but related papers, focused on health professional’s perspectives on if and how technology can improve care processes and delivery. The empirical study of Bowden et al 1 explored clinicians’ perceptions of digital access to patients’ past medical history (PMH) as a basis for justifying significant investment into shared electronic health records (SEHR). Bates et al 2 work reported a roundtable expert discussion on the challenges and future direction in smart medication management.

Bowden et al surveyed clinicians from the front line, those in emergency departments and providing urgent care. In these time critical environments, clinicians reported that access to PMH is imperative to be able provide a response that accounts for heath status, current treatment regime and other health data related to the immediate presentation. Clinician’s valued and wanted to obtain information from a trusted SEHR; there is a high level of technology acceptance. Five major suggested improvements were identified: increasing the number of patient records available; standardisation of information presentation; increased system reliability; expanded access to information and validation by authoritative/trusted sources. Two policy implications were identified: the need to focus on higher levels of patient participation; and, to ensure patient record curation and stewardship increasing the breadth and depth of information and processes.

Bates et al work records an expert discussion on the challenges and future direction in smart medication management. The key focus of the discussion was to reconsider the critical question: how can the original goal of improved healthcare quality and medication safety through electronic medical records be achieved? The challenges identified relate to established individual behaviours and beliefs, defined care delivery systems, and inflexible service requirements. They suggest that improvements are to be found through addressing simultaneously four interrelated issues: digital and information technology systems; safe prescribing; communication and education of both clinicians and patients; and medication adherence.

Individually, and together, Bowden et al and Bates et al highlight the need for a whole of systems approach that encompasses all healthcare providers to develop, implement, evaluate and improve technology to enhance care processes and delivery. They bring to attention, once again, that end-user involvement, including the pressing need for increased patient involvement, will likely raise the uptake and success of technology driven improvements.3 4 Each work promotes renewed recognition that addressing usability and human factors are critical to building safe and effective health systems and care delivery processes.5–7

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  • Contributors Initial conception design and drafting of the manuscript: DG, UI and Y-CL. Drafting the manuscript: DG and UI. Critical revision of the paper: DG, UI and Y-CL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.