Can we make health IT safe enough for patients?

Health information technology (HIT) is widely believed to be an essential modality for improving the efficiency, effectiveness, and safety of healthcare, and has its adoption has been vigorously promoted. However, the safety of commercially available HIT systems has never been independently and rigorously assessed. This paper discusses critical issues to be considered in the development of safe and reliable HIT, and identifies a group of structural impediments that may slow or prevent the arrival of HIT that is actually safe enough for routine clinical use. It argues that this situation is analogous to NASA's promotion of the space shuttle not as an experimental, risky technology, but rather as a routine, ready-for-ordinary-use resource.

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

[2]  T. Brennan,et al.  INCIDENCE OF ADVERSE EVENTS AND NEGLIGENCE IN HOSPITALIZED PATIENTS , 2008 .

[3]  T. Brennan,et al.  Incidence of adverse events and negligence in hospitalized patients. , 1991, The New England journal of medicine.

[4]  Nancy G. Leveson,et al.  Safeware: System Safety and Computers , 1995 .

[5]  Capers Jones,et al.  Why software fails , 1996 .

[6]  E. Ackermann.  The Quality in Australian Health Care Study. , 1996, The Medical journal of Australia.

[7]  Neil R. Storey,et al.  Safety-critical computer systems , 1996 .

[8]  Felix Redmill,et al.  Human Factors in Safety-Critical Systems , 1997 .

[9]  James T. Reason,et al.  Managing the risks of organizational accidents , 1997 .

[10]  Marc Berg,et al.  Rationalizing Medical Work: Decision-support Techniques and Medical Practices , 2022 .

[11]  K. J. Vicente,et al.  Cognitive Work Analysis: Toward Safe, Productive, and Healthy Computer-Based Work , 1999 .

[12]  T. Brennan,et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. , 2000, Medical care.

[13]  René Amalberti,et al.  The paradoxes of almost totally safe transportation systems , 2001 .

[14]  C. Vincent,et al.  Adverse events in British hospitals: preliminary retrospective record review , 2001, BMJ : British Medical Journal.

[15]  Enrico Coiera,et al.  Health Information Management: Integrating Information and Communication Technology in Health Care Work , 2003 .

[16]  Mark Keil,et al.  Software project risks and their effect on outcomes , 2004, CACM.

[17]  Alan J. Forster,et al.  Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital , 2004, Canadian Medical Association Journal.

[18]  Christopher Nemeth,et al.  The Messy Details: Insights From the Study of Technical Work in Healthcare , 2004 .

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

[20]  R. Wears,et al.  Computer technology and clinical work: still waiting for Godot. , 2005, JAMA.

[21]  D. Coplen.  Types of Unintended Consequences Related to Computerized Provider Order Entry , 2007 .

[22]  Jennifer Lai,et al.  Unintended Consequences of Information Technologies in Health Care—An Interactive Sociotechnical Analysis , 2007 .

[23]  Jonathan P. Weiner,et al.  Comment: "e-Iatrogenesis": The Most Critical Unintended Consequence of CPOE and other HIT , 2007, J. Am. Medical Informatics Assoc..

[24]  R. Wears.  The chart is dead--long live the chart. , 2008, Annals of emergency medicine.

[25]  A. Podgurski,et al.  Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems , 2008 .

[26]  Nancy G. Leveson,et al.  “Safeware”: Safety-Critical Computing and Health Care Information Technology , 2008 .

[27]  Why Electronic Health Record Systems Require Safety Regulation , 2009 .

[28]  A. Egberts,et al.  The Effect of Computerized Physician Order Entry on Medication Prescription Errors and Clinical Outcome in Pediatric and Intensive Care: A Systematic Review , 2009, Pediatrics.

[29]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[30]  Hua Xu,et al.  Data from clinical notes: a perspective on the tension between structure and flexible documentation , 2011, J. Am. Medical Informatics Assoc..