Electronic health records and national patient-safety goals
Open accessAbstract
Hospitals and clinics are adapting to new technologies and implementing electronic health records, but the efforts need to be aligned explicitly with goals for patient safety. EHRs bring the risks of both technical failures and inappropriate use, but they can also help to monitor and improve patient safety.
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Digital systems reduce visibility of system state and process integrity, making HIT hazards latent and detected indirectly through downstream consequences.
“Digital systems frequently mediate clinical work in ways that reduce direct visibility of system state and process integrity.”
From Why digital health fails silently: a sociotechnical theory of health information technology–related risk (2026) · cites this paper as [28]
In Phase 1, the paper says EHR operations can be opaque to end users, making problems difficult to detect, and describes data-transfer errors that can be virtually undetectable. This supports the citing sentence’s point about reduced visibility in clinical digital systems. It does not establish that HIT hazards are generally detected indirectly through downstream consequences. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOrganisational guidance such as the SAFER Guides reflects a shift by emphasising governance, monitoring, and continuous self-assessment as essential components of EHR safety, rather than treating safety as a function of software reliability alone.
“Organisational guidance such as the SAFER Guides reflects this shift by emphasising governance, monitoring, and continuous self-assessment as essential components of EHR safety, rather than treating safety as a function of software reliability alone (28, 48).”
From Why digital health fails silently: a sociotechnical theory of health information technology–related risk (2026) · cites this paper as [28]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSafer digital healthcare depends on strengthening organisational capacity to detect emerging hazards, contain their effects, and learn from system-level vulnerabilities.
“Rather than focusing primarily on preventing individual errors, the findings suggest that safer digital healthcare depends on strengthening organisational capacity to detect emerging hazards, contain their effects, and learn from system-level vulnerabilities (28, 55).”
From Why digital health fails silently: a sociotechnical theory of health information technology–related risk (2026) · cites this paper as [28]
The second phase addresses unsafe or inappropriate use of technology and unsafe changes in overall workflow that emerge due to technology use.
“The second phase addresses unsafe or inappropriate use of technology as well as unsafe changes in the overall workflow that emerge due to technology use.”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [27]
The first phase of the three-phase model concerns safety events unique and specific to technology (unsafe technology), which often emerge early in implementation.
“The first phase is concerned with safety events that are unique and specific to technology (ie, unsafe technology), which often emerge early in the process of implementation.”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [27]
The boundaries between the three phases may not always be distinct.
“While the boundaries between the phases may not always be distinct”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [27]
The third phase addresses use of technology proactively to identify and monitor potential safety concerns before patient harm occurs.
“The third phase addresses use of technology proactively to identify and monitor potential safety concerns before harm occurs to the patient.”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [27]
Sittig and Singh proposed a three-phase model to account for variation in stages of implementation, levels of complexity, and related patient safety concerns within an EHR-enabled healthcare system.
“Therefore, to understand the intersection of EHR and patient safety , Sittig and Singh 27 further proposed a three-phase model to account for the variation in the stages of implementation, levels of complexity, and related patient safety concerns within an EHR-enabled healthcare system.”
From Exploring the sociotechnical intersection of patient safety and electronic health record implementation (2014) · cites this paper as [27]
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Patients' safety in the era of EMR/EHR automation
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Digital transformation of hospital quality and safety: real-time data for real-time action
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Meeting the Health Information Needs of Prostate Cancer Patients Using Personal Health Records
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Shuaib, W., Hilmi, J., Caballero, J., Rashid, I., Stanazai, H., Ajanovic, A., Moshtaghi, A., Amari, A., Tawfeek, K., Khurana, A., et al. (2017) · Health Informatics Journal · doi:10.1177/1460458217692930 · Cited by 39 · see citing works
Challenges in patient safety improvement research in the era of electronic health records
Russo, E. M., Sittig, D. F., Murphy, D. R., & Singh, H. (2016) · Healthcare · doi:10.1016/j.hjdsi.2016.06.005 · Cited by 39 · see citing works
Self-citationKlein, D. O., Rennenberg, R. J. M. W., Koopmans, R. P., & Prins, M. H. (2020) · Journal of Patient Safety · doi:10.1097/pts.0000000000000670 · Cited by 37 · see citing works
Health Information Exchange in Emergency Medicine
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Cole-Lewis, H. J., Smaldone, A. M., Davidson, P. G., Kukafka, R., Tobin, J. N., Cassells, A. N., Mynatt, E. D., Hripcsak, G. M., & Mamykina, L. (2015) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2015.08.003 · Cited by 35 · see citing works
Callahan, T. J., Barnard, J. G., Helmkamp, L. J., Maertens, J., & Kahn, M. G. (2017) · eGEMs (Generating Evidence & Methods to improve patient outcomes) · doi:10.5334/egems.214 · Cited by 36 · see citing works
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Diagnostic errors: moving beyond ‘no respect’ and getting ready for prime time
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Self-citationStockwell, D. C., Bisarya, H., Classen, D. C., Kirkendall, E. S., Lachman, P. I., Matlow, A., Tham, E., Hyman, D., Lehman, S. M., Searles, E., et al. (2014) · Journal of Patient Safety · doi:10.1097/pts.0000000000000139 · Cited by 30 · see citing works
Adeghe, E. P., Okolo, C. A., & Ojeyinka, O. T. (2024) · World Journal of Biology Pharmacy and Health Sciences · doi:10.30574/wjbphs.2024.17.3.0133 · Cited by 33 · see citing works
Electronic health record–related safety concerns: A cross‐sectional survey
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Self-citationQuan, K. A., Yim, J., Merrill, D., Khusbu, U., Madey, K. M., Dickey, L. L., Dangodara, A. A., Rudkin, S., O’Brien, M., Thompson, D., et al. (2018) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2018.32 · Cited by 29 · see citing works
Tapp, H., Ludden, T., Shade, L. E., Thomas, J., Mohanan, S., & Leonard, M. K., Jr. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2019.101036 · Cited by 29 · see citing works
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Adelson, K. B., Qiu, Y., Evangelista, M., Spencer-Cisek, P., Whipple, C., & Holcombe, R. F. (2014) · Journal of Oncology Practice · doi:10.1200/jop.2013.001184 · Cited by 28 · see citing works
Patient safety goals for the proposed Federal Health Information Technology Safety Center
Sittig, D. F., Classen, D. C., & Singh, H. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002988 · Cited by 28 · see citing works
Self-citationWeb-based Citation Management Tools: Comparing the Accuracy of Their Electronic Journal Citations
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Resilient practices in maintaining safety of health information technologies
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Self-citationSittig, D. F., Sherman, J. D., Eckelman, M. J., Draper, A., & Singh, H. (2022) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocac137 · Cited by 26 · see citing works
Self-citationThe impact of electronic records on patient safety: a qualitative study
Scantlebury, A., Adamson, J., Watt, I. S., Sheard, L., Cairns, P. A., & Wright, J. (2016) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-016-0299-y · Cited by 28 · see citing works
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Standardized Care Pathways as a Means to Improve Patient Safety.
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Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative
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Self-citationNursing knowledge captured in electronic health records
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Continuing Patient Care during Electronic Health Record Downtime
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The Safety of Outpatient Health Care
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Nurse Assistant Communication Strategies About Pressure Ulcers in Nursing Homes
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Identifying peripheral arterial disease cases using natural language processing of clinical notes
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Enabling Large-Scale Biomedical Analysis in the Cloud
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Safe Use of Health Information Technology
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A red‐flag‐based approach to risk management of EHR‐related safety concerns
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Self-citationDiabetes management challenges in Iran: A qualitative content analysis
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Evaluation of the patient with an exposure-related disease
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Self-citationReducing wrong patient selection errors: exploring the design space of user interface techniques.
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Toward More Proactive Approaches to Safety in the Electronic Health Record Era
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Self-citationWeak Professional Interactions as main Cause of Medication Errors in Intensive Care Units in Iran
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Data saves lives: optimising routinely collected clinical data for rare disease research
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- Authors
- Sittig, D. F., & Singh, H.
- Affiliations
- Memorial Hermann (US)
- Michael E. DeBakey VA Medical Center (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-11-08
- Volume
- 367
- Issue
- 19
- Pages
- 1854-1860
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3690003
- OpenAlex
- W2116241811
- Cited by
- 204
- References
- 48
- Citations by year
- 2026: 11 · 2025: 4 · 2024: 13 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 10 · 2019: 16 · 2018: 20 · 2017: 13 · 2016: 25 · 2015: 23 · 2014: 28 · 2013: 22 · 2012: 1
- FWCI
- 38.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R18HS017820)
- National Cancer Institute (K23CA125585)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- electronic health records, patient safety, National Patient Safety Goals, EHR implementation, technical failure, patient safety monitoring, hospitals
- MeSH terms
- Goals, Humans, Software, United States, Medical Records Systems, Computerized, Computer Security, American Recovery and Reinvestment Act, Electronic Health Records, Patient Safety, Meaningful Use
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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