Describing and disarming health information system snares that capture and conceal characters.

Abstract

Characters in computing are symbols that stand for a single unit of data such as a number, alphabetical letter, or punctuation mark. In health information entry and exchange, correct encoding and decoding of characters in computing is essential for accurate documentation and interpretation of information. When something goes wrong and there are changes to or deletions of the intended characters, there is missing or inaccurate data in the health information system. Due to the very nature of health information systems, it is difficult to detect when information is missing. Another hidden attribute that is invisible to users is the way characters are interpreted by computing systems. Lost and invisible information can lead to patient safety issues.The Food and Drug Administration (FDA) Maude database and the Institute for Safe Medication Practice (ISMP) describe a few isolated issues with computing characters and health information. Though the loss of health information due to failure to correctly translate computing characters would seem to be a problem with potentially high severity, we were unable to locate a collection of reported issues or a discussion summarizing fail-safe and error-tolerant system designs addressing this topic area. The human factors and human-centered design communities are uniquely knowledgeable and skilled for addressing issues with visibility of system states and error-tolerant design and would be in an ideal position for considering solutions to this issue.In this paper, we review and group issue reports on characters in computing and information entry and exchange. We reflect on human factors and safety engineering principles for designing systems to prevent, detect, and mitigate latent issues in this problem space. Furthermore, we explore special characters that present with added challenges when used in computing systems.To facilitate fail-safe interoperability and health information exchange, systems will require designs that address latent issues brought on by hidden attributes of characters in computing. Using human factors and safety engineering principles, we can help prospectively design to detect and disarm the snares found within and across health information systems.