On the Safety of Electronic Medical Records

Information and communication technology is rapidly transforming modern health care systems. Electronic Medical Records (EMRs) systems have replaced traditional forms of storing, processing, interpreting and exchanging patient health information in many health care organizations. However, an increasing number of concerns are raised about the quality of EMR systems and industry regulators are pondering ways to ensure safer health information technologies. This paper discusses fundamental concepts associated with the safety of EMR systems, describes current approaches to regulating the industry, and discusses limitations of traditional safety engineering methods with respect to their application to EMR systems. We then present a domain-specific adaptation of Leveson's system-theoretic model STAMP for safety engineering of EMR systems and demonstrate its application with a real-world case study.

[1]  Nancy G. Leveson,et al.  Engineering a Safer World: Systems Thinking Applied to Safety , 2012 .

[2]  N. Shaw,et al.  Bad Health Informatics Can Kill – Is Evaluation the Answer? , 2005, Methods of Information in Medicine.

[3]  Nancy G. Leveson,et al.  A new accident model for engineering safer systems , 2004 .

[4]  Richard J. Holden,et al.  Cognitive performance-altering effects of electronic medical records: an application of the human factors paradigm for patient safety , 2011, Cognition, Technology & Work.

[5]  Vimla L. Patel,et al.  A cognitive taxonomy of medical errors , 2004, J. Biomed. Informatics.

[6]  Nicola T Shaw,et al.  Electronic health records and patient safety: what lessons can Canada learn from the experience of others? , 2008, Healthcare quarterly.

[7]  J. Reason.  Human error: models and management , 2000, BMJ : British Medical Journal.

[8]  David A. Kreda,et al.  Health care information technology vendors' "hold harmless" clause: implications for patients and clinicians. , 2009, JAMA.

[9]  A. Localio,et al.  Role of computerized physician order entry systems in facilitating medication errors. , 2005 .

[10]  James Williams,et al.  Regulation of patient management software. , 2010, Health law journal.

[11]  Gilad J. Kuperman,et al.  Case Report: Comprehensive Analysis of a Medication Dosing Error Related to CPOE , 2005, J. Am. Medical Informatics Assoc..

[12]  Nancy G Leveson,et al.  Software safety: why, what, and how , 1986, CSUR.

[13]  Jens H. Weber-Jahnke,et al.  A preliminary study of apparent causes and outcomes of reported failures with patient management software , 2011 .

[14]  Robyn Tamblyn,et al.  Review Paper: The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review , 2005, J. Am. Medical Informatics Assoc..

[15]  Yang Gong,et al.  Developing a Nomenclature for EMR Errors , 2009, HCI.

[16]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[17]  Roger B. Davis,et al.  Overrides of medication alerts in ambulatory care. , 2009, Archives of internal medicine.

[18]  Karim Keshavjee,et al.  Building a Pan-Canadian Primary Care Sentinel Surveillance Network: Initial Development and Moving Forward , 2009, The Journal of the American Board of Family Medicine.

[19]  村田 和義,et al.  HCI International 2009 , 2009, Universal Access in the Information Society.

[20]  J. Loeb,et al.  The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near misses and adverse events. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[21]  Leon J. Osterweil,et al.  Workshop on software Engineering in Health Care (SEHC) , 2009, ICSE Companion.

[22]  B. Karsh,et al.  A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional , 2006, Quality and Safety in Health Care.

[23]  J. P. Kichak,et al.  Computerized physician order entry: helpful or harmful? , 2003, Journal of the American Medical Informatics Association : JAMIA.

[24]  W B Runciman,et al.  A classification for incidents and accidents in the health-care system. , 1998, Journal of quality in clinical practice.

[25]  Enrico W. Coiera,et al.  Viewpoint: Improving Clinical Communication: A View from Psychology , 2000, J. Am. Medical Informatics Assoc..

[26]  Julie A. Jacko,et al.  Interacting in various application domains , 2009 .

[27]  M. Leonard,et al.  The human factor: the critical importance of effective teamwork and communication in providing safe care , 2004, Quality and Safety in Health Care.

[28]  B M Fried,et al.  FDA regulation of medical software. , 2000, Journal of health law.