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An analysis of electronic health record-related patient safety concerns
Open accessAbstract
OBJECTIVE: A recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs). We analyzed EHR-related safety concerns reported within a large, integrated healthcare system. METHODS: The Informatics Patient Safety Office of the Veterans Health Administration (VA) maintains a non-punitive, voluntary reporting system to collect and investigate EHR-related safety concerns (ie, adverse events, potential events, and near misses). We analyzed completed investigations using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety. Using the framework analysis approach to qualitative data, we identified emergent and recurring safety concerns common to multiple reports. RESULTS: We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70%) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or 'hidden dependencies' within the EHR. DISCUSSION: EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after 'go-live' and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA. CONCLUSIONS: Because EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
Analysis of 100 closed VA investigations of EHR-related safety concerns found that most involved unsafe technology and complex interactions across sociotechnical dimensions. Four recurring concern types accounted for 94% of incidents, showing that EHR safety concerns persist long after go-live even in a mature EHR system.
Key findings
- Of 100 consecutive, unique, closed investigations from August 2009 to May 2013, 74 involved unsafe technology (phase 1), 25 involved unsafe use of technology (phase 2), and 1 involved lack of monitoring (phase 3); 70% involved two or more sociotechnical model dimensions.
- Four concern types accounted for 94% of incidents: unmet display needs (n=36), software modifications/upgrades (n=24), system–system interface failures (n=17), and hidden dependencies in distributed systems (n=17).
- The most commonly involved sociotechnical dimensions were hardware/software (76), clinical content (38), workflow/communication (35), human–computer interface (29), and people (20).
- Incidents came from 55 unique VA facilities; IPS safety scores were low for 48 investigations, intermediate for 38, and high for 14.
Methods
- Retrospective qualitative analysis of completed EHR-related safety investigations from the Veterans Health Administration Informatics Patient Safety Office, using 100 consecutive unique closed investigations extracted from 344 reported incidents.
- Used framework analysis guided by Sittig and Singh’s eight-dimension sociotechnical model and three EHR safety phases; two authors independently indexed concerns, resolving discrepancies by consensus.
- Coded narrative investigation reports in Atlas.ti V.6.2 and arranged data in Microsoft Excel; no inter-rater reliability was reported because the aim was descriptive.
Limitations
- The paper states all incidents involved the same EHR within a single, albeit very large, healthcare system; findings may not generalize to institutions with different organizational characteristics, EHR infrastructure, or reporting mechanisms.
- The paper states the data ranged from unsafe conditions to patient harm, did not analyze additional patient outcome data, and that reporting captures fewer than 10% of medical errors, so prevalence rates cannot be calculated.
- The paper notes self-reported data may be limited by recall bias or reporter knowledge; evident from the text, the retrospective voluntary reporting system and exclusion of duplicate or comingled-record concerns may underrepresent the full universe of EHR-related safety concerns.
Model-written summary. Check it against the paper before relying on it.
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Claims the paper makes
36 Own result · 19 Not checked yet · 15 Own interpretation · 11 Own method · 7 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These incidents also spanned both phase 1 (11 incidents) and phase 2 (6 incidents) of EHR safety.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concern of hidden dependencies in distributed systems
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Across the 36 concerns within this concern type, the contributory dimensions were hardware and software (22 incidents), human–computer interface (22 incidents), workflow and communication (10 incidents), clinical content (9 incidents), people (9 incidents), organizational policies and procedures (2 incidents), and system measurement and monitoring (1 incident).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One-quarter were classified as phase 2 (ie, unsafe EHR use) and most commonly involved the dimensions of people, clinical content, workflow and communication, and human–computer interface.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“First, a pharmacist made a data entry error while approving the order for a larger-than-usual amount of diuretic.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plainSingle case- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All four types of safety concerns affected, or had the potential to affect, multiple patients, although we did not further analyze outcome data except as noted below.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sociotechnical dimensions of phase 1 concerns most commonly involved hardware and software, workflow and communication, and clinical content.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The over-ride released the incorrect dose for administration by nursing staff.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Owing to diminished user confidence in the warning's reliability, the warning was over-ridden.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most (22 of 36) of these concerns were classified as phase 1 issues, followed by 13 phase 2, and one phase 3.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Safety concerns involving hidden dependencies and system–system interfaces are not mutually exclusive.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concern of hidden dependencies in distributed systems
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One configuration error involved a disease management package that, after local implementation, was found to have erroneously escalated user privileges to place and sign orders.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One-quarter were classified as phase 2 (ie, unsafe EHR use) and most commonly involved the dimensions of people, clinical content, workflow and communication, and human–computer interface.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We analyzed 17 cases where the primary safety concern involved system–system interfaces, the means by which information is transferred from one EHR component to another.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to system–system interfaces
plainn = 17- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents.”
- Also stated in: § Results · plain
“We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents.”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Results · plain
In the paper
“Patient safety concerns in this category often involved maintaining a unique patient's context, a process designed to keep various individual EHR components centered on a single patient as the user traverses the EHR components.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to system–system interfaces
What the sources say
- Not checked yetcites [51] Sittig DF Teich JM Yungton JA . Preserving context in a multi-tasking clinical environment: a pilot implementation. Proc AMIA Annu Fall Symp 1997; 784–8.
plaincorrelationaln = 17- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We analyzed 100 unique, consecutive investigations of EHR-related safety concerns reported to and investigated by the VA's Informatics Patient Safety Office.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The second most common concern type involved upgrades to the EHR or one of its components, or improperly configured software (24 incidents).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, one incident described an inadvertent change to a configuration file during an update to the EHR that prevented the EHR from communicating with the printing system used to label laboratory specimens.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The main contributing sociotechnical dimensions of this concern type were hardware and software (21 incidents), clinical content (10 incidents), and workflow and communication (5 incidents).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As an example, one incident described a situation in which a patient was administered a dose of a diuretic that exceeded the prescribed amount.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plainSingle case- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Seventy-four involved unsafe technology and 25 involved unsafe use of technology.”
- Also stated in: § Results · plain
“Approximately three-quarters of safety concerns were categorized as phase 1 (ie, concerns related to unsafe technology).”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only one safety concern involving phase 3 (ie, failure to use the EHR to monitor patient safety) was represented in our analysis.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Safety concerns typically emerged from complex interactions of multiple sociotechnical aspects of the EHR system.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All incidents of this concern category were coded as phase 1 EHR use.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to system–system interfaces
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.”
- Also stated in: § Results · plain
“Table 2 provides definitions and examples of these four types of concerns, which accounted for 94% of the incidents analyzed.”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Unmet display needs was the most common type of concern observed (36 incidents).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Having a mature EHR system clearly does not eliminate EHR-related safety concerns, and a majority of reported incidents were phase 1 or unsafe technology.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Some safety concerns had relatively straightforward origins, such as simultaneous use of multiple instances of an EHR application by a single user, leading to order entry on the wrong patient.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We found that, even within a well-established EHR infrastructure, many significant EHR-related safety concerns related to both unsafe technology and unsafe use of technology remain.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All four emergent safety concerns affected, or had the potential to affect, multiple patients, but we did not analyze additional data on patient outcomes as a result of these concerns.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other problems had more complex origins, such as user misinterpretation of information presented through the EHR's user interface.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Detecting and preventing EHR-related safety concerns is challenging because concerns are often multifaceted, involving not only potentially unsafe technological features of the EHR but also EHR user behaviors, organizational characteristics, and rules and regulations that guide EHR-related activities.”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“In addition, conceptual frameworks or models have been developed to incorporate the breadth of technical and non-technical factors into the analysis of EHR safety and effectiveness.21 25 27 32 33”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“A few studies have attempted to quantify and classify EHR-related safety concerns by mining patient safety incident reporting databases.18 29–31”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Despite a clear need to define and understand EHR-related safety concerns,28 data that describe the nature and magnitude of these concerns are scarce.”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
- Not checked yetcites [28] Health Information Technology Safety Action & Surveillance Plan. The Office for the National Coordinator of Health Information Technology 2013 July 2 [cited 2013 Jul 11]; http://www.healthit.gov/sites/default/files/safety_plan_master.pdf
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“However, emerging evidence suggests that HIT may cause new patient safety concerns and other unintended consequences due to usability issues, disruptions of clinical processes, and unsafe workarounds to circumvent technology-related constraints.2–16”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
- Not checked yetcites [2] source
- Not checked yetcites [3] source
- Not checked yetcites [4] source
- Not checked yetcites [5] source
- Not checked yetcites [6] source
- Not checked yetcites [7] source
- Not checked yetcites [8] source
- Not checked yetcites [9] source
- Not checked yetcites [10] source
- Not checked yetcites [11] source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“In particular, rapid adoption of electronic health records (EHRs) has revealed potential safety concerns related to EHR design, implementation, and use.12 17–21”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
- Not checked yetcites [12] Institute of Medicine (IOM). Health IT and Patient Safety: Building Safer Systems for Safer Care. Washington, DC: The National Academies Press, 2012.
- Not checked yetcites [17] source
- Not checked yetcites [18] source
- Not checked yetcites [19] source
- Not checked yetcites [20] Harrington L Kennerly D Johnson C . Safety issues related to the electronic medical record (EMR): synthesis of the literature from the last decade, 2000–2009. J Healthc Manag 2011;56:31–43. source
- Not checked yetcites [21] Meeks DW Takian A Sittig DF . Exploring the sociotechnical intersection of patient safety and electronic health record implementation. J Am Med Inform Assoc 2014;21(e1) e28 34. source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source.”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Discussion
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This example highlights complex interactions between the hardware and software, human–computer interface, people, and workflow and communication dimensions, which served to either prevent or obscure the users’ receipt of appropriate information.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This error occurred due to a number of interacting sociotechnical factors.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Previous studies have largely used isolated event reports without benefit of an independent human factors and informatics investigation to analyze safety concerns in the EHR.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
What the sources say
- Not checked yetcites [18] source
- Not checked yetcites [29] source
- Not checked yetcites [30] source
- Not checked yetcites [31] Sparnon E Marella WM . The role of the electronic health record in patient safety events. Harrisburg, PA: Pennsylvania Patient Safety Authority; 2012.
- Not checked yetcites [55] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Because EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them.”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Conclusions
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“Previous exploratory studies in patient safety have been able to shed powerful light on contributory factors with a similar sample size.44”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data collection
What the sources say
- Not checked yetcites [44] source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In conclusion, our study demonstrates the potential utility of analyzing patient safety concerns using a sociotechnical approach to account for the complexities of using EHRs.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
boostedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study was unable to capture the universe of EHR-related safety concerns that might be occurring.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“While studies using self-reported data, including this one, are limited by the possibility of reporters’ recall bias or knowledge,56 our methods may allow for a more complete representation of an incident and the underlying safety concern.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
What the sources say
- Not checked yetcites [56] source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All incidents were related to use of the same EHR within a single, albeit very large, healthcare system.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Having a mature EHR system clearly does not eliminate EHR-related safety concerns, and a majority of reported incidents were phase 1 or unsafe technology.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
boosted- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The four categories that emerged from our analysis appear to represent significant safety concerns that need to be addressed with current and future EHR implementations.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: unclear — It is unclear whether it could be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 26
- Probably not a substantial claim. 20
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the reports documented a variety of EHR-related safety incidents, four broad types of safety concerns were prominent: unmet data display needs within the EHR; problems with software modifications or upgrades; concerns related to system–system interfaces; and hidden dependencies within the EHR.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Since these printers were installed and configured before recruitment of the current staff, the configuration error was not immediately recognized.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Another concern involved ‘legacy’ software (ie, an older system that has not evolved despite newer technologies50) that needed an upgrade or maintenance, but support staff did not have sufficient knowledge of these systems.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
What the sources say
- Not checked yetcites [50] Brodie ML Stonebraker M . Migrating legacy systems: gateways, interfaces & the incremental approach. Morgan Kaufmann Publishers Inc., 1995.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The selected incidents were reported from 55 unique VA facilities.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We classified these concerns into four types: unmet display needs in the EHR, safety concerns with software modifications or upgrades, concerns related to data transmission at system–system interfaces, and concerns of ‘hidden dependencies’ in distributed systems (ie, when one EHR component unexpectedly or unknowingly is affected by the state or condition of another).”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A majority (70%) involved two or more model dimensions.”
- Also stated in: § Results · plain
“Incidents frequently reflected occurrence of more than one sociotechnical dimension: 40 incidents were classified with two sociotechnical dimensions, 23 incidents had three, and seven involved four dimensions.”
§ An analysis of electronic health record-related patient safety concerns > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Incidents in this category were also noted to be largely dependent on multiple interactions between these dimensions, and only one incident was coded with a single dimension.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concern of hidden dependencies in distributed systems
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Patient context-related concerns were caused by network failures, conflicts created by non-EHR software, and EHR upgrades that were not compliant with context protocols.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to system–system interfaces
plaindirectn = 17- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This concern type was most often associated with phase 1 EHR safety (21 incidents). Three concerns were classified as phase 2, and none were phase 3.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As highlighted in this example, the system–system interface concern involved interactions from multiple sociotechnical dimensions: hardware and software (17 incidents), workflow (6 incidents), and content (5 incidents).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to system–system interfaces
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The concerns of hidden dependencies primarily involved the dimensions of hardware and software (14 of 17 incidents), workflow (14 incidents), clinical content (9 incidents), and people (5 incidents).”
§ An analysis of electronic health record-related patient safety concerns > Results > Concern of hidden dependencies in distributed systems
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Although a dose error warning appeared on order entry, this particular warning was known to have a high false positive rate.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plainSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On the IPS-assessed safety scores, 48 investigations were scored low, 38 intermediate, and 14 were scored high.”
§ An analysis of electronic health record-related patient safety concerns > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The nurse, unaware of the discrepancy between the prescribed amount and the amount approved by the pharmacist, administered the larger dose.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirectSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“For instance, we previously developed a sociotechnical model that proposes eight interdependent dimensions that are essential to understand EHR-related safety (table 1; Sittig and Singh model).24 34”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“The model accounts for the complexities of technology, its users, the involved workflow, and the larger external or organizational policies and context in assessment of EHR-related safety concerns.35 36”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Investments in health information technology (HIT) can enhance the safety and efficiency of patient care and enable knowledge discovery.1”
§ An analysis of electronic health record-related patient safety concerns > Background and significance
What the sources say
- Not checked yetcites [1] Institute of Medicine (IOM). Crossing the quality chasm a new health system for the 21st century. The National Academy Press, 2001.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Members of our multidisciplinary project team, whose areas of expertise included clinical medicine, patient safety, informatics, human factors, and information technology, provided guidance on the content of the themes.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As compared with system–system interfaces, hidden dependencies are unknown, and therefore potential points of failure and possible safety concerns may not be readily identified.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concern of hidden dependencies in distributed systems
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This example demonstrates how a complex interaction of a technical dimension with non-technical dimensions can potentially develop into a safety concern.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to both intended and unintended software modifications
boostedconditionalSingle case- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As a result of this poor fit, the displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm.”
§ An analysis of electronic health record-related patient safety concerns > Results > Concerns related to unmet data display needs in the EHR
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Given the rich nature of the qualitative data, we believed this number was both valuable and feasible.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data collection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“We do not report inter-rater reliability because the aim of the study was to describe the nature and context of common EHR-related safety concerns, not solely classification according to the sociotechnical models.47 49”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data analysis
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus, a completed investigation provides additional contextual details pertinent to the incident under study as compared with traditional event reports.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Design and setting
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The two coding authors (ie, a physician with informatics training and a human factors engineer) independently indexed each safety concern after reviewing the results of the IPS investigation. Discrepancies in coding were then resolved by consensus.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Although these are known safety concerns,43 they were excluded because they are not routinely analyzed by IPS and are handled primarily by a separate office in the VA.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data collection
What the sources say
- Not checked yetcites [43] source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“First, two authors (DWM and MWS) independently reviewed and summarized the investigation reports to become familiar with the data, but at this secondary stage of analysis, we made no further effort to replicate the safety concern or investigation, determine additional causes, or offer additional solutions.”
§ An analysis of electronic health record-related patient safety concerns > Methods > Data analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Despite capturing a low percentage of errors, we were able to gain insight about non-technical aspects of EHR-related safety concerns that may not be routinely considered in technology-focused investigations.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Nevertheless, our findings may not represent all types of EHR-related safety concerns and might not be generalizable to other institutions with different organizational characteristics, EHR infrastructure, or patient safety reporting mechanisms.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings underscore the importance of continuing the process of detecting and addressing safety concerns long after EHR implementation and ‘go-live’ has occurred.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the analysis of unsafe conditions or near misses is useful to illustrate concerns in EHR-enabled care, we acknowledge that their circumstances or implications may be different from adverse events that result in patient harm.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“In general, fewer than 10% of medical errors are captured through reporting, and such data do not allow us to calculate prevalence rates.56 59 60”
§ An analysis of electronic health record-related patient safety concerns > Discussion
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The data used for our analysis were composed of safety concerns that ranged from unsafe conditions to patient harm.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All four emergent safety concerns affected, or had the potential to affect, multiple patients, but we did not analyze additional data on patient outcomes as a result of these concerns.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Additional strengths of our study include the nationwide distribution of our sample of EHR-related safety incidents and the relatively sophisticated implementation and use of the EHR across the VA healthcare system.39”
§ An analysis of electronic health record-related patient safety concerns > Discussion
What the sources say
- Not checked yetcites [39] Spetz J Burgess JF Phibbs CS . What determines successful implementation of inpatient information technology systems? Am J Manag Care 2012;18:157–62.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“As an early adopter of EHRs, the VA has evolved into a ‘learning system’ that dedicates resources to investigating safety concerns and making EHR-related safety improvements decades after first launch.42”
§ An analysis of electronic health record-related patient safety concerns > Discussion
What the sources say
- Not checked yetcites [42] Taylor L Wood SD Chapman R . Analysis and Mitigation of Reported Informatics Patient Safety Adverse Events at the Veterans Health Administration. Human Factors and Ergonomics Society, 2012. source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although the sample size is smaller than that of some other studies, the case descriptions were rich (ie, 2–4 single-spaced pages), spanned a period of 3 years, and represented a continuum of care from home-based primary care to large, urban medical centers.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study suggests that technology-based solutions alone will only partially mitigate concerns and that interventions to improve EHR-related safety should encompass the people, organizations, systems, and policies that influence how EHRs are used.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Safety concerns we identified had complex sociotechnical origins and would need multifaceted strategies for improvement.”
§ An analysis of electronic health record-related patient safety concerns > Discussion
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper relies on this without support.
Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA.
“Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA.”
The paper relies on this without support.
Few healthcare systems have robust reporting and analytic infrastructure similar to the VA's Informatics Patient Safety Office.
“However, few healthcare systems have robust reporting and analytic infrastructure similar to the VA's IPS.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“This study has also added to an emerging but limited UK evidence base that has reported potential negative impacts of electronic records on the doctor-patient relationship [35] and patient safety in secondary care [36–38].”
From Exploring the implementation of an electronic record into a maternity unit: a qualitative study using Normalisation Process Theory (2017) · cites this paper as [36]
Citations
Cites
Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013) · BMC Medical Research Methodology · doi:10.1186/1471-2288-13-117 · Cited by 10,865
Crossing the Quality Chasm: A New Health System for the 21st Century
Baker, A. (2001) · BMJ · doi:10.1136/bmj.323.7322.1192 · Cited by 10,779
Qualitative research in health care: Analysing qualitative data
Pope, C. (2000) · BMJ · doi:10.1136/bmj.320.7227.114 · Cited by 8,131
The SAGE Encyclopedia of Qualitative Research Methods
Given, L. (2008) · doi:10.4135/9781412963909 · Cited by 6,134
Qualitative methods for health research
Green, J., & Thorogood, N. (2009) · Choice Reviews Online · doi:10.5860/choice.47-0901 · Cited by 4,612
Qualitative Research in Health Care
(2006) · Wiley eBooks · doi:10.1002/9780470750841 · Cited by 2,747
Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors
Koppel, R. (2005) · JAMA · doi:10.1001/jama.293.10.1197 · Cited by 2,126
Leavitt, M. (2001) · PubMed · Cited by 1,835
Work system design for patient safety: the SEIPS model
Carayon, P., Schoofs Hundt, A., Karsh, B.-T., Gurses, A. P., Alvarado, C. J., Smith, M., & Flatley Brennan, P. (2006) · Quality in Health Care · doi:10.1136/qshc.2005.015842 · Cited by 1,795
Self-citationAsh, J. S. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1471 · Cited by 1,789
Research works printed but not linked: 1
- Institute of Medicine (IOM). Health IT and Patient Safety: Building Safer Systems for Safer Care. Washington, DC: The National Academies Press, 2012.
Cited by
Sorted by citations
Electronic Health Records: Then, Now, and in the Future
Evans, R. S. (2016) · Yearbook of Medical Informatics · doi:10.15265/iys-2016-s006 · Cited by 816
“Mounting pressure will require EHR implementations to build a robust infrastructure to monitor and learn from adverse events, errors, and potential adverse events and errors [204].”
Kim, M. O., Coiera, E., & Magrabi, F. (2017) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocw154 · Cited by 263
“System configuration issues were also linked to software updates, eg, decision support errors following updates to a drug database.(26) Sociotechnical contextual variables that contributed to information errors were identified in 71% of studies (n1⁄424).”
BackgroundReport of the AMIA EHR-2020 Task Force on the status and future direction of EHRs
Payne, T. H., Corley, S., Cullen, T. A., Gandhi, T. K., Harrington, L., Kuperman, G. J., Mattison, J. E., McCallie, D. P., McDonald, C. J., Tang, P. C., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv066 · Cited by 220
Current challenges in health information technology–related patient safety
Sittig, D. F., Wright, A. T., Coiera, E. W., Magrabi, F., Ratwani, R. M., Bates, D. W., & Singh, H. (2018) · Health Informatics Journal · doi:10.1177/1460458218814893 · Cited by 183
“55 This must change if we are to gather enough data to identify common modes of failure and estimate the likelihood of similar future events.”
BackgroundSelf-citationSingh, H., & Sittig, D. F. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004486 · Cited by 167
Self-citation
Metadata
- Authors
- Meeks, D. W., Smith, M. W., Taylor, L., Sittig, D. F., Scott, J. M., & Singh, H.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- United States Department of Veterans Affairs (US)
- Memorial Hermann (US)
- Corresponding author
- Singh, Hardeep
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-11
- Volume
- 21
- Issue
- 6
- Pages
- 1053-1059
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC4215044
- OpenAlex
- W2148595420
- Semantic Scholar
- 9b75d5d6ec4e36813fe145af295d58b9926d0372
- Cited by
- 207
- References
- 60
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 16 · 2023: 13 · 2022: 14 · 2021: 15 · 2020: 10 · 2019: 24 · 2018: 22 · 2017: 25 · 2016: 30 · 2015: 20 · 2014: 2
- FWCI
- 46.82
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of the American Medical Informatics Association (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs (14-274, CIN13-413, USA 14-274)
- Office of Research and Development (CIN 13-413)
- Health Services Research and Development (CIN 13‐413, CRE12-033, USA 14-274)
- Agency for Healthcare Research and Quality (R01HS022087)
- U.S. Public Health Service (T32HP10031)
- Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413, 13–413)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- electronic health records, patient safety, socio-technical model, near misses, software upgrade, data transmission, hidden dependencies, workflow, EHR implementation, safety reporting, Veterans Health Administration
- MeSH terms
- Humans, Retrospective Studies, United States, United States Department of Veterans Affairs, Medical Errors, Workflow, Electronic Health Records, Patient Safety
About these checks
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.
A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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