Presentation
The Application of the SEIPS Framework in a Digital Health Context: A Scoping Review
SessionPoster Session 1
DescriptionBackground
Digital health interventions (DHI) are being introduced at an unprecedented rate, often leading to short sighted and rushed implementations that fail to integrate effectively into clinical practice. These poorly integrated solutions can result in inefficiencies, user frustration, and risks to patient safety. Recognising these challenges, the World Health Assembly Resolution on Digital Health has called on the World Health Organisation to develop evidence-based guidelines that support the design, implementation and evaluation of DHIs. A holistic, systems-based approach using Human Factors and Ergonomics (HFE) principles is essential to ensure that all the domains that interact within a complex, learning health system are considered.
Whilst there has been an emphasis on HFE and systems thinking in healthcare, its integration into the design and implementation of DHIs remains inconsistent. The Systems Engineering Initiative for Patient Safety (SEIPS) framework, which has been widely used to guide research and improve healthcare systems and patient safety, offers a structured approach that could support more consistent and effective integration of these principles into DHI development. SEIPS offers a holistic visual representation of work as done to build organisation awareness, describe systems, and identify barriers and facilitators within work processes. This understanding supports more effective problem solving and enables better integration of future interventions by accounting for the complex interactions between social and technical elements in healthcare.
There are three main versions of the SEIPS model, each representing an evolution in how healthcare systems and HFE interact: (1) The original SEIPS 1.0. model, focuses on how work systems affect patient safety and health-related outcomes, (2) SEIPS 2.0. expands the original model to include the contribution of patients, families, and other non-professions, and (3) SEIPS 3.0 emphasises the dynamic nature of healthcare processes, focusing on the patient journey. Additionally, SEIPS 101 has been designed as a practice-orientated version for use by practitioners and researchers, rather than making a theoretical contribution, and provides seven simple tools for practical application. Although the theoretical framework of SEIPS has been applied across a range of health care settings, its use with DHI appears heterogenous and underexamined. A comprehensive review of the literature is therefore needed to map the extent and nature of SEIPS applications in this context, to identify gaps in knowledge, and inform future research and practice.
This scoping review aimed to (1) examine the key characteristics of where SEIPS has been applied with DHI (e.g., setting, how and at what stage of the technology cycle SEIPS has been applied, DHI, users), (2) understand the types of problems that are being addressed using SEIPS in this context (i.e. design, evaluation, identification of problems, understanding systems, or a range of applications), and (3) examine the usability and effectiveness of SEIPS to address the problem.
Methods
A literature search was undertaken across four databases (Medline, Psycinfo, Web of Science and CINAHL). The search was conducted on the 23rd of June 2025. A scoping review protocol was registered with the Open Science Framework (DOI 10.17605/OSF.IO/RJCU4).
Titles and abstracts, and full texts were screened by six reviewers in pairs against the eligibility criteria. Conflicts were resolved with discussion until consensus was reached. Included studies were peer-reviewed research publications including conference proceedings and review papers that used the SEIPS frameworks in a digital health context. Outcomes that were related to usability and that described any level of the technology cycle (design, implementation, evaluation, sustainability) were included. Papers that reported on technology that generated usable data were included. Included populations were users of SEIPS, e.g., clinicians, quality and safety people, external professionals (researchers or human factors/ergonomics people). Papers were restricted to those available in English, and there was no date restriction. All study designs (mixed-methods, qualitative, quantitative), including case studies were included. Our exclusions were outcomes that focused on processes, algorithms, simulations, data sources, or peripherals that did not generate usable data (e.g. medical imaging). Study protocols, dissertations, theses, editorials and commentaries were not included.
Results
Among the 24 studies included in the review, 15 were conducted in the USA, three in the Netherlands, and one in each of Australia, China, France, Norway, Malaysia, South Korea and Myanmar. The settings included large university hospitals (n=7), primary health/medical centres (n=5), outpatient clinics including pharmacy and radiology (n=6), residential aged care homes (n=2), an internet hospital (n=1), and in-home (n=1).
SEIPS was most often used to support evaluation (n = 17), with limited application to design (n = 3) and implementation (n = 1) of DHIs. The DHIs included computerised order entry, clinical decision support, mHealth, electronic health records, telemedicine, patient portals, risk prediction models and an incident reporting system. SEIPS was also used to examine medication administration and antimicrobial stewardship processes. The study investigators had a background in HFE (n = 16), HFE and industrial engineering (n = 3), HFE and pharmacy (n = 2), HFE and biomedical informatics (n = 2), and health informatics (n = 2).
SEIPS helped identify key influences on DHI use, such as user experience (person), interruptions (task), software issues (technology), resource constraints (organisation), and workspace design (environment). SEIPS was reported to be a usable and effective framework in a DHI context. However, one study reported that SEIPS could not account for transitions between different work systems and dynamic environments with levels of uncertainty such as emergency departments.
Conclusion
This review highlights that SEIPS is a usable framework that offers a practical solution for understanding problems within DHI work systems. It has identified a critical gap in applying HFE approaches during the design and implementation of DHIs.
Digital health interventions (DHI) are being introduced at an unprecedented rate, often leading to short sighted and rushed implementations that fail to integrate effectively into clinical practice. These poorly integrated solutions can result in inefficiencies, user frustration, and risks to patient safety. Recognising these challenges, the World Health Assembly Resolution on Digital Health has called on the World Health Organisation to develop evidence-based guidelines that support the design, implementation and evaluation of DHIs. A holistic, systems-based approach using Human Factors and Ergonomics (HFE) principles is essential to ensure that all the domains that interact within a complex, learning health system are considered.
Whilst there has been an emphasis on HFE and systems thinking in healthcare, its integration into the design and implementation of DHIs remains inconsistent. The Systems Engineering Initiative for Patient Safety (SEIPS) framework, which has been widely used to guide research and improve healthcare systems and patient safety, offers a structured approach that could support more consistent and effective integration of these principles into DHI development. SEIPS offers a holistic visual representation of work as done to build organisation awareness, describe systems, and identify barriers and facilitators within work processes. This understanding supports more effective problem solving and enables better integration of future interventions by accounting for the complex interactions between social and technical elements in healthcare.
There are three main versions of the SEIPS model, each representing an evolution in how healthcare systems and HFE interact: (1) The original SEIPS 1.0. model, focuses on how work systems affect patient safety and health-related outcomes, (2) SEIPS 2.0. expands the original model to include the contribution of patients, families, and other non-professions, and (3) SEIPS 3.0 emphasises the dynamic nature of healthcare processes, focusing on the patient journey. Additionally, SEIPS 101 has been designed as a practice-orientated version for use by practitioners and researchers, rather than making a theoretical contribution, and provides seven simple tools for practical application. Although the theoretical framework of SEIPS has been applied across a range of health care settings, its use with DHI appears heterogenous and underexamined. A comprehensive review of the literature is therefore needed to map the extent and nature of SEIPS applications in this context, to identify gaps in knowledge, and inform future research and practice.
This scoping review aimed to (1) examine the key characteristics of where SEIPS has been applied with DHI (e.g., setting, how and at what stage of the technology cycle SEIPS has been applied, DHI, users), (2) understand the types of problems that are being addressed using SEIPS in this context (i.e. design, evaluation, identification of problems, understanding systems, or a range of applications), and (3) examine the usability and effectiveness of SEIPS to address the problem.
Methods
A literature search was undertaken across four databases (Medline, Psycinfo, Web of Science and CINAHL). The search was conducted on the 23rd of June 2025. A scoping review protocol was registered with the Open Science Framework (DOI 10.17605/OSF.IO/RJCU4).
Titles and abstracts, and full texts were screened by six reviewers in pairs against the eligibility criteria. Conflicts were resolved with discussion until consensus was reached. Included studies were peer-reviewed research publications including conference proceedings and review papers that used the SEIPS frameworks in a digital health context. Outcomes that were related to usability and that described any level of the technology cycle (design, implementation, evaluation, sustainability) were included. Papers that reported on technology that generated usable data were included. Included populations were users of SEIPS, e.g., clinicians, quality and safety people, external professionals (researchers or human factors/ergonomics people). Papers were restricted to those available in English, and there was no date restriction. All study designs (mixed-methods, qualitative, quantitative), including case studies were included. Our exclusions were outcomes that focused on processes, algorithms, simulations, data sources, or peripherals that did not generate usable data (e.g. medical imaging). Study protocols, dissertations, theses, editorials and commentaries were not included.
Results
Among the 24 studies included in the review, 15 were conducted in the USA, three in the Netherlands, and one in each of Australia, China, France, Norway, Malaysia, South Korea and Myanmar. The settings included large university hospitals (n=7), primary health/medical centres (n=5), outpatient clinics including pharmacy and radiology (n=6), residential aged care homes (n=2), an internet hospital (n=1), and in-home (n=1).
SEIPS was most often used to support evaluation (n = 17), with limited application to design (n = 3) and implementation (n = 1) of DHIs. The DHIs included computerised order entry, clinical decision support, mHealth, electronic health records, telemedicine, patient portals, risk prediction models and an incident reporting system. SEIPS was also used to examine medication administration and antimicrobial stewardship processes. The study investigators had a background in HFE (n = 16), HFE and industrial engineering (n = 3), HFE and pharmacy (n = 2), HFE and biomedical informatics (n = 2), and health informatics (n = 2).
SEIPS helped identify key influences on DHI use, such as user experience (person), interruptions (task), software issues (technology), resource constraints (organisation), and workspace design (environment). SEIPS was reported to be a usable and effective framework in a DHI context. However, one study reported that SEIPS could not account for transitions between different work systems and dynamic environments with levels of uncertainty such as emergency departments.
Conclusion
This review highlights that SEIPS is a usable framework that offers a practical solution for understanding problems within DHI work systems. It has identified a critical gap in applying HFE approaches during the design and implementation of DHIs.
Authors
Event Type
Poster Presentation
TimeMonday, March 234:45pm - 6:15pm EDT
LocationRhinelander Gallery
Digital Health