Via Dolorosa

Tracing harm from fragmented records and siloed decisions

This is the abstract from the pre-print submitted on 23 Feb 2026. Please see the full manuscript as submitted to JMIR.

We will update as the article moves through peer-review.

Digital health fragmentation and patient safety outcomes with respect to antimicrobial prescribing: A rapid evidence review

Authors: Verena Schneider; Akish Luintel; Bethan Balch; Shivani Gangadia; Grainne Brady; Emma McGuire; Gwenan M. Knight; Laura Shallcross; Steve Harris; Cecilia Vindrola-Padros

Background

Prior microbiology results, resistance patterns, and antimicrobial exposure are central to safe and effective antimicrobial prescribing. Digital health fragmentation refers to the dispersal of patient data across multiple electronic systems and the associated challenge of accessing complete information at the point of care. Antimicrobial prescribing for infections represents a critical use case to investigate the impact of digital health fragmentation on patient care. While interoperability has been studied in the context of patient safety, no review has described digital health fragmentation within the UK and examined its impact on antimicrobial prescribing and antimicrobial stewardship (AMS).

Objective

To (1) characterise the extent of digital health fragmentation in the UK, (2) summarise the available evidence on its impact on AMS and prescribing practices, and (3) identify potential solutions.

Methods

A rapid review of the peer-reviewed literature was conducted following published guidance for rapid reviews and the PRISMA statement. MEDLINE ALL and PsycInfo were searched on 19 August 2025 using search terms relating to digital health fragmentation/interoperability, patient safety, and antimicrobial use. Searches were limited to English-language publications from 2015 (for characterising the recent trends/current state of digital health fragmentation in the UK) or 2010 onwards (for AMS-related impacts and solutions). Screening was conducted by four researchers following pre-defined inclusion and exclusion criteria. Extracted data were synthesised narratively through framework analysis. Study quality was appraised using the Mixed Methods Appraisal Tool.

Results

Fourteen studies met the inclusion criteria. Ten studies described the extent and nature of digital health fragmentation in the UK. Digital health fragmentation affects a large number of patients and is linked to clinical care efficiency, quality and safety risks, including limited access to external clinical records, missing or incomplete information, duplicate investigations, delays in decision‑making, and substantial time spent searching for data. Evidence specific to antimicrobial prescribing was limited (four studies) but indicated that AMS relies on information spread across multiple systems, with poor interoperability disrupting workflows, hindering communication, and undermining stewardship activities. Only one study reported the development of a digital tool designed to address digital health fragmentation and support stewardship.

Conclusions

Digital health fragmentation negatively affects patient care across the UK, yet evidence on which specific aspects of fragmentation most undermine antimicrobial stewardship remains scarce. AMS represents a critical use case to understand how and why digital health fragmentation has detrimental impacts on patient safety and the need for investment and innovation. Given the urgency of the global antimicrobial resistance crisis, future research should therefore quantify the scale and impact of fragmentation for AMS to direct investment and innovation in digital infrastructure and clinical-supportive solutions. Clinical Trial: PROSPERO (CRD420251126067)