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  • Illustrate a range of hazards to patient safety arising from electronic information systems

  • Compare several conceptual frameworks for analyzing errors and risks of health information technology

  • Review strategies for reducing adverse events related to electronic devices in healthcare settings

  • Information technology is a cannon rolling around the deck of health care; properly controlled, it is a powerful tool for effectiveness, efficiency, and safety, yet its weight and momentum demand constant attention


Health care is not a system, it’s an ecologya sustained by information. Health information technology (HIT) comprises the electronic devices and software programs that support health care, give access to it, and watch over it. This chapter looks at how these tools advance and also threaten patient welfare. The core of this discussion surrounds electronic health records (EHRs). However, these are tightly entwined with other programs such as monitoring, communications, and decision support.

aAnother label might be, “complex adaptive system.” The behavior of a standard system can be calculated from a given set of inputs. The behavior of an ecology is harder to predict.

A few decades ago, a treatise on healthcare safety would have been dominated by human factors such as knowledge, judgment, and skill; perhaps drug purity. Compared to other high-performance industries, health care was slow to implement computers for everyday tasks, let alone complex decision making. But, today, technology—both as a solution and as a hazard—is of central concern to the field of patient safety. HIT is both the salvation and nemesis of clinicians overwhelmed by an information deluge. It is taken for granted by trainees, exasperates midcareer providers, and is cited as a reason for early retirement by senior practitioners.

It is treacherous to analyze technology while standing on the slope of an adoption curve. See Figure 23.1.

Figure 23.1

Innovation adoption curve. (Data from Rogers E. Diffusion of Innovations. New York: The Free Press of Glencoe; 1962:162.)

The pace of development, implementation, revision, and abandonment of HIT is so intense it is hard to find a stable platform from which to make durable observations. (Ironically, this follows decades when HIT was just party talk among quirky enthusiasts.) The speed of change creates challenges when contemplating the impact of HIT upon safety, access, cost, care effectiveness, and the experiences of patients and providers.

Compare the adoption of pharmaceuticals. Before a drug is released, there are trials followed by surveillance, while safety and effectiveness are methodically understood by communities of researchers, clinicians, and regulators. Development and regulatory processes are often criticized for being sluggish, as is the speed of disseminating therapies that seem promising.b It takes cleverness to predict whether knowledge about 1 chemical can be extrapolated to a related chemical, ...

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