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Working ICMM abstract

Release status: CURRENT-PASS POPULATED WORKING DRAFT; NOT YET SUBMISSION READY. The current-pass results are populated and automatically checked. A final search rerun, independent evidence check, author/affiliation details, portal validation and deadline resolution remain release gates.

Title

Learning from Patient Harm to Design Safer Military Electronic Health Records

Title length: 11 words.

Introduction/Background

Military health services are digitising to improve clinical capability, force health readiness, continuity and interoperability across garrison, deployed, multinational and civilian settings. Electronic health record (EHR) failures can also create pathways to harm. In England and Wales, coroners may publish Prevention of Future Deaths reports when an investigation identifies action required to reduce the risk of similar deaths. This study examined whether that public safety intelligence could inform military health-information systems across different levels of digital maturity.

Methods

We mapped and thematically synthesised targeted Regulation 28 evidence from selected reports dated 2018–14 July 2026. We completely enumerated and extracted the 2018 publication cohort, retaining 36 contextual decisions; later-migration checking was limited and 2019–2026 discovery targeted. Reports were eligible when record design, workflow, results management, communication, interoperability, decision support, registration, information availability or a paper–electronic boundary formed part of the circumstances, concern or preventive action. Included reports were multi-coded using nine sociotechnical domains, then translated into candidate testable military EHR safety requirements.

Results

Eighty-seven unique candidates were screened; 71 reports were included. The leading non-exclusive domains were governance and assurance (60), action ownership and closed-loop workflow (54), information visibility (45), human factors and usability (43), interoperability and continuity (39), and decision support and alerting (31). Reports distinguished information being stored from being visible, delivered, owned, actioned and closed. Derived requirements prioritised positive patient identification, population visibility, accountable critical-result escalation, closed-loop tasking, auditable transfer, civil–military information exchange, hybrid-record provenance and safe degraded operation.

Conclusion

Independent death investigations provide a practical input to military digital-health requirements engineering. Their lessons are relevant to mature EHRs and incremental digitisation, but the selected published corpus is not epidemiological evidence, coding was by one reviewer, and military requirements require validation in representative workflows. Known pathways to harm should become explicit safety barriers and assurance tests before capability deployment or replacement.

Keywords

Military medicine, electronic health records, patient safety, digital health, interoperability

Body word count: 300 words using the repository's whitespace-delimited Markdown-stripped check. Verify against the submission portal's counter before release.

The official guidance describes this four-part scientific structure as typical. It is retained because it is the clearest fit for this study, not because the published wording makes these exact headings mandatory.

Release gates

  • [x] Replace every bracketed field with audited current-pass data.
  • [x] Confirm body is 250–300 words under the documented local counting rule.
  • [ ] Resolve the official deadline conflict (event page: 3 August; parent page: 14 July) in the submission portal.
  • [ ] Confirm theme and oral format in the submission portal.
  • [x] State the key single-reviewer and selected-corpus limitations in the abstract.
  • [ ] Complete case-to-source audit.