Oncology Technology Risks Extend Beyond Patient Harm

Technology-related safety problems in oncology often arise from misalignment between digital systems, clinical workflows and communication rather than from isolated technical faults. Published in JAMIA Open, a qualitative investigation at a large Canadian cancer centre examined how these problems affected patients, care delivery and the healthcare workforce. Accounts from oncology nurses linked administrative failures, fragmented documentation and organisational processes with missed appointments, delayed treatment, inefficient work and emotional strain. Nurses also described repeatedly compensating for system weaknesses through additional checking, coordination and monitoring, creating an informal layer of safety work that was essential to care but largely unrecognised. 

Administrative and Documentation Failures Dominate 

The investigation involved 28 oncology nurses working across outpatient, chemotherapy, inpatient, radiation and supportive care settings. Semistructured interviews and small focus groups generated 98 accounts of technology-related safety events. Each event was examined through three established frameworks covering the type of incident, contributing sociotechnical conditions and resulting harm. 

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Clinical administration, documentation and organisational management together accounted for most reported events. Nurses described missed or incorrectly transferred appointments, fragmented patient records, medication orders placed where they were difficult to locate and information that did not update when needed. These problems affected both individual patients and wider groups, particularly during transitions between electronic health record systems. 

Several accounts showed how administrative processes could directly affect clinical care. Automatically updated room information contributed to a clinician speaking with the wrong patient. Appointments that were not transferred to a new system left some patients unseen for extended periods while their cancer progressed and symptoms worsened. In other cases, cancelled scans, unbooked biopsies or incomplete scheduling steps caused delays. 

Documentation problems also affected decision-making. Infection control information was difficult to find or could not be updated because key test details were unavailable. Medication orders could appear valid to one professional but remain invisible or unactionable to nursing staff because different electronic views or encounter structures separated related information. Nurses linked these failures to disrupted care, added workload and persistent uncertainty about whether critical information had been missed. 

Workflow Misalignment Creates Recurring Risk 

Workflow and communication problems were the most frequently identified sociotechnical contributors, followed by people-related factors and human-computer interface issues. These elements often occurred together, showing that technology-related harm did not usually result from a single defective component. Instead, risk developed where software structures, professional roles, clinical routines and organisational processes failed to align. 

Encounter-based electronic record structures were a recurring source of difficulty. Medication orders entered under a different encounter from the one connected to a scheduled appointment could be hidden from nurses. Staff then had to search through numerous encounters, sometimes without knowing where pharmacy had placed the order. Related scheduling and treatment steps were also separated. A clinician could enter hydration orders without activating an additional scheduling command, leaving clerical staff unaware that a booking was required. 

Interface design magnified these coordination problems. Small actions, such as failing to click one additional button, could prevent appointments from being generated. Information split across screens or treatment systems required repetitive navigation and encouraged workarounds. Nurses described searching records, contacting other professionals and creating double-checking processes to keep care moving. 

Inconsistent engagement with electronic systems further shifted responsibility towards nurses. Clinicians who used the system less regularly could struggle to keep pace with changes or forget required steps. Nurses then provided technical support and corrected gaps to maintain clinic flow, even when this work fell outside their formal role. The resulting monitoring and coordination became routine but remained largely invisible within organisational safety systems. 

Patient, Workforce and System Harms Interconnect 

The most common consequences were health system inefficiency, damage to workforce well-being and physical or emotional harm to patients. These effects frequently overlapped. Delayed appointments, missed diagnostics and treatment disruption could increase patient distress or contribute to disease progression, while the effort required to identify and correct failures added frustration, moral distress and burnout for staff. 

Appointment communication was a prominent example. Some patients received little notice of visits or were unaware that an appointment had been arranged. Nurses sometimes began assessments with patients unaware why they were being contacted. Missing or fragmented information about other specialists also made care coordination slower, forcing nurses to search external websites or ask patients to reconstruct their care history. 

Repetitive record navigation consumed time and reduced confidence that all relevant orders had been found. Nurses described multiple staff searching from different points in a long list of encounters while remaining uncertain that nothing had been overlooked. System delays could also produce distressing consequences after a patient’s death, with staff contacting bereaved families about appointments before the electronic record reflected the death. 

Across the accounts, minor technical or administrative gaps could cascade into broader harm. Delayed status updates, copied information, incomplete protocol signalling and disconnected ordering processes created points where risk escalated. Nurses frequently buffered these weaknesses by tracing orders, contacting providers, monitoring unreliable alerts and developing parallel checks. Making this compensatory work visible could support organisational learning and reveal where digital systems depend on unplanned human effort. 

Technology-related safety risks in oncology are embedded in the interaction between electronic systems, clinical work and organisational processes. Administrative breakdowns, fragmented documentation and disconnected workflows can delay care, create uncertainty and increase emotional strain for patients and staff. Nurses often prevent these problems from progressing through additional coordination and monitoring, but this work remains largely unrecognised. Safer system design requires closer alignment between related clinical steps, information across encounters and the realities of complex oncology care, while reducing reliance on informal workarounds to maintain safety. 

Source: JAMIA Open 

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