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Original research
Effects of interorganisational information technology networks on patient safety: a realist synthesis
  1. Justin Keen1,
  2. Maysam Ali Abdulwahid1,
  3. Natalie King1,
  4. Judy M Wright1,
  5. Rebecca Randell2,
  6. Peter Gardner3,
  7. Justin Waring4,
  8. Roberta Longo1,
  9. Silviya Nikolova1,
  10. Claire Sloan1,
  11. Joanne Greenhalgh5
  1. 1Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  2. 2Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
  3. 3School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
  4. 4Health Services Management Centre, University of Birmingham, Birmingham, UK
  5. 5Sociology and Social Policy, University of Leeds, Leeds, UK
  1. Correspondence to Dr Justin Keen; J.Keen{at}


Objective Health services in many countries are investing in interorganisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home.

Design Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews.

Eligibility criteria The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital.

Information sources 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts.

Outcomes Changes in patients’ clinical risks.

Results We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.

There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks.

Conclusions Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems.

PROSPERO registration number CRD42017073004.

  • information technology
  • health policy
  • quality in health care
  • risk management

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  • Twitter @jmwleeds, @HCIforHealthIT

  • Contributors PG, JG, JK, RL, RR, JW and JMW developed the proposal for the study. NK and JMW designed and undertook structured database searches. MAA, JG and JK undertook screening and data extraction. PG and JW provided specialist input to the design and interpretation of specific searches. All authors, including SN and CS, contributed to the detailed study design and to the interpretation of overall findings. All authors either drafted or commented on drafts of this article.

  • Funding National Institute for Health Research-Health Services and Delivery Research programme (project 16/53/03).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Leeds Faculty of Medicine and Health Ethics Committee (MREC 17-004).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The majority of material in this article is derived from already published articles and reports. Beyond this, other methods were qualitative and the data generated are not suitable for sharing. Further information can be obtained from the corresponding author.