Understanding the Limits of Patient Safety Classification Systems for Health Information Technology-Related Incidents

Patient safety classification systems are fundamental to surveillance, organizational learning, research, and governance because they enable adverse events and near misses to be organized into standardized categories for comparison and analysis. However, the increasing complexity of health information technology (HIT)-related patient safety incidents challenges the assumptions underpinning conventional classification approaches, as these incidents often emerge from dynamic, distributed, and evolving sociotechnical interactions rather than discrete, time-bounded events. In this Viewpoint, I argue that many of the challenges associated with classifying HIT-related patient safety incidents arise not simply from limitations of individual classification systems but from the inherent representational logic of classification itself. By viewing classification as a knowledge practice rather than merely a technical tool for organizing incident data, I contend that abstraction, boundary-setting, and standardization inevitably simplify complex sociotechnical processes and constrain how safety problems are represented, interpreted, and acted upon. I discuss 4 recurring representational limitations that characterize the application of patient safety classification systems to HIT-related incidents: fragmentation of sociotechnical interactions, loss of temporality and evolving processes, inadequate representation of scale and propagation across systems, and normalization of "use error" through simplified attribution of responsibility. These limitations can contribute to incomplete organizational learning, misaligned safety interventions, and challenges in interpreting and comparing classified patient safety data across health care settings. Rather than arguing against the continued use of patient safety classification systems, I propose that their strengths and limitations should be recognized simultaneously. Classification remains indispensable for surveillance, learning, and governance, but it should be interpreted as one component of a broader sociotechnical understanding of patient safety. Recognizing the representational limits of classification can support more reflexive interpretation of classification-based evidence and encourage complementary approaches that better capture the complexity of HIT-related patient safety.