Objective: This study explored healthcare quality issues affecting the reporting and investigation levels of digital incidentreporting systems.

Methods: A total of 38 health information technology-related incident reports (free-text narratives) were collected from oneof Sweden’s national incident reporting repositories. The incidents were analysed using an existing framework, i.e., theHealth Information Technology Classification System, to identify the types of issues and consequences. The frameworkwas applied in two fields, ‘event description’ by the reporters and ‘manufacturer’s measures’, to assess the quality of report-ing incidents by the reporters. Additionally, the contributing factors, i.e., either human or technical factors for both fields,were identified to evaluate the quality of the reported incidents.

Results: Five types of issues were identified and changes made between before-and-after investigations: Machine to soft-ware-related issues (n = 8), machine to use-related issues (n = 5), software to software-related issues (n = 5), use to soft-ware-related issues (n = 4) and use to use-related issues (n = 1). Over two-thirds (n = 15) of the incidents demonstrated achange in the contributing factors after the investigation. Only four incidents were identified as altering the consequencesafter the investigation.

Conclusion: This study shed some light on the issues of incident reporting and the gap between the reporting and investi-gation levels. Facilitating sufficient staff training sessions, agreeing on common terms for health information technology sys-tems, refining the existing classifications systems, enforcing mini-root cause analysis, and ensuring unit-based localreporting and standard national reporting may help bridge the gap between reporting and investigation levels in digitalincident reporting.