EHR Safety: The Way Forward to Safe and Effective Systems
Open accessAbstract
Diverse stakeholders--clinicians, researchers, business leaders, policy makers, and the public--have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 48 cited sources checked · 0 supported · 0 flagged
- Findingcitation
In organizations with mature EHRs, including the authors', clinicians consider easy access to test results, observations, decision support, and e-messaging essential to care quality and patient safety.
“In those organizations, including those of the authors, clinicians regard easy access to test results, clinician observations, clinical-decision support, and e-messaging as vital to care quality and patient safety.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] source
Not checked in the free run.
- Premisecitation
The third study, in a children's hospital subpopulation, found mortality doubled from 2.8% to 6.6% after CPOE implementation.
“The third study, conducted in a subpopulation of a children's hospital, documented a doubling of mortality (from 2.8% to 6.6%) after CPOE implementation.23”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] source
Not checked in the free run.
- Premisecitation
The number of identified EHR-related flaws rises sharply with each new software deployment, including initial implementations and upgrades.
“The identification of EHR-related flaws increases markedly with every new software deployment (both original implementations and upgrades).22,42”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [22] source
Not checked in the free run.
- cites [42]
Not checked in the free run.
- Premisecitation
The fourth study, in the same hospital, found no significant mortality change.
“The fourth study, conducted in the same hospital, showed no significant change in mortality.24”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [24] source
Not checked in the free run.
- Premisecitation
The first two widely cited CPOE studies did not demonstrate improvements in patient outcomes.
“Although the first two studies have been widely cited as showing CPOE benefits, neither showed improvements in patient outcomes.20 -22”
Quote in the paperSubstantial claim0 of 3 sources checked
- Premisecitation
The health care literature shows that EHRs can contribute to safety incidents and patient harm.
“Complicating matters, the health care literature documents the potential of EHRs to contribute to safety incidents and patient harm.1,23,30 -33”
Quote in the paperSubstantial claim0 of 6 sources checked - Premisecitation
Only five studies have examined overall safety and effectiveness.
“Although some measures of error showed improvement, overall safety and effectiveness have been addressed in only five studies.[21][22][23][24][25]”
Quote in the paperSubstantial claim0 of 5 sources checked - Premisereasoning
Limited research literature makes it difficult to assess the overall safety and effectiveness of EHR use.
“Assessing the overall safety and effectiveness of EHR use is made difficult by the limited research literature.”
Quote in the paperSubstantial claim - Premisecitation
Initial broad classifications of safety incidents have come from published accounts of CPOE-related errors.
“Published reports of CPOE-related errors have provided initial, high-level typologies of safety incidents.30,44,45”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [30] source
Not checked in the free run.
- cites [44]
Not checked in the free run.
- cites [45]
Not checked in the free run.
- Interpretationreasoning
Effectiveness reports from early EHR adopters may not apply to the less customized EHRs and implementations that most organizations will use.
“Because of this extensive customization (a type of overfitting), reports of EHR-related effectiveness from these organizationsalthough important as efficacy studies-may not be generalizable to the less customized EHRs and EHR implementations that most organizations will use.”
Quote in the paperSubstantial claim- Rests on an assumption: The decades-long iterative development of early EHRs improved the fit between the software and the organization, users, and care processes.
- Rests on an assumption: In the first organizations to use EHRs, software designers knew the organization, the users, and the care processes the EHR was meant to support.
- Interpretationcitation
The safety and effectiveness of EHRs are likely to differ substantially across different organizations.
“The safety and effectiveness of EHRs in these different organizations are likely to vary significantly.11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] source
Not checked in the free run.
- Premisecitation
The overall safety and effectiveness of electronic health records have not been demonstrated.
“Although the benefits of well-managed EHRs may seem obvious and are likely substantial, the overall safety and effectiveness of EHRs have not been shown.1,2”
Quote in the paperSubstantial claim0 of 2 sources checked - Interpretationcitation
The order-entry focus of those typologies is a major limitation because flaws and incidents occur beyond order entry.
“However, their focus on order entry is a substantial limitation, because flaws and incidents are not limited to the order entry phase of care.46”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46]
Not checked in the free run.
- Premisecitation
Another systematic review found a similarly negative result for EHR use and outpatient care quality.
“Another systematic review of the effect of EHR use on the quality of outpatient care came to a similarly negative conclusion.29”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] source
Not checked in the free run.
- Premisecitation
Multiple organizations working together have found and recorded thousands of possible EHR safety defects.
“Beyond these published reports, several organizations have collectively identified and documented thousands of potential EHR-related safety flaws.34”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34] source
Not checked in the free run.
- Premisecitation
When multiple EHR components are integrated, interactions among them are a leading source of EHR-related flaws.
“Indeed, where multiple EHR components are integrated (for example, order entry, nursing and pharmacy order processing, and medication administration documentation), one of the most important sources of EHR-related flaws is the interactions among the components.15”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [15] source
Not checked in the free run.
- Premisecitation
Published typologies have not covered how the level of clinical-decision-support automation affects safety flaws and their chance of causing an incident.
“In addition, the published typologies have not addressed such critical issues as the effect of the level of clinical-decision-support automation on safety flaws and their likelihood of contributing to a safety incident.14,47”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [14] source
Not checked in the free run.
- cites [47]
Not checked in the free run.
- Interpretationreasoning
As organizations with limited resources for process transformation, human factors, software safety, and project management adopt EHRs, EHR-related harm may become more likely.
“As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase.”
Quote in the paperSubstantial claim- Rests on an assumption: Smaller hospitals and most physician practices likely lack the resources to mount such an initiative.
- Premisecitation
Leapfrog has developed a system to test the safety and effectiveness of implemented order entry systems.
“Leapfrog has taken an important preparatory step by developing a system for testing the safety and effectiveness of implemented order entry systems.41”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41]
Not checked in the free run.
- May combine two claims. 6
- Classified as probably not a substantial claim. 2
May combine two claims.
PremisecitationEHRs are complex technological innovations that affect workflows, communication, job roles, working conditions, and job security.
“Because EHRs are particularly complex technology innovations-affecting workflows, communications, job definitions, working conditions, and job security-demonstrat-ing and improving their safety is critically important.[5][6][7][8][9][10]”
Quote in the paperSubstantial claim0 of 6 sources checkedMay combine two claims.
PremisecitationThe fifth study found that 31% of physicians and 56% of nurses thought the EHR improved overall care.
“The fifth study found that only thirty-one percent of physicians and fifty-six percent of nurses believed that the EHR contributed to improvement of care overall.25”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25] source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationUsing an EHR safely and effectively demands new organizational policies, workflows, work systems, job roles, and training.
“This approach will reinforce the fact that safe and effective use of an EHR requires new organizational policies, processes, work systems, job descriptions, and education.38,39”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [38]
Not checked in the free run.
- cites [39]
Not checked in the free run.
May combine two claims.
PremisecitationThe second study found more medication errors and adverse drug events, which decreased after the CPOE interface was improved.
“In fact, the second study reported an increase in medication errors and adverse drug events, which was reversed after an improvement in the CPOE interface.22”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
Not checked in the free run.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationChaudhry et al.'s systematic review concluded that in most settings it is hard to know what benefits to expect from health information technology and how to implement it for maximum value.
“A more recent systematic review of health care information technology (largely EHRs) by Chaudhry et al. concluded that in most health care settings, it may be difficult “to determine what benefits to expect from health information technology use and how best to implement the system in order to maximize the value derived.”27”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] source
Not checked in the free run.
May combine two claims.
PremisecitationMost available studies were conducted by EHR developers and examined only a few error types related to order entry (CPOE).
“The few available studies have largely been conducted by the developers of the EHRs and have focused on the effect of order entry (CPOE) systems on a limited number of error types.[17][18][19][20]”
Quote in the paperSubstantial claim0 of 4 sources checkedMay combine two claims.
PremisecitationA systematic review of outpatient CPOE found only four safety studies and concluded there is inadequate evidence that CPOE improves safety or reduces cost in outpatient settings.
“A systematic review of outpatient CPOE systems found only four studies that addressed safety and concluded, “the relatively small number of evaluation studies published to date do not provide adequate evidence that CPOE systems enhance safety and reduce cost in the outpatient settings.”28”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [28] source
Not checked in the free run.
The paper relies on this without support.
Widespread EHR adoption is necessary to achieve many American health care goals, including better care quality and patient safety.
“There is a growing consensus that widespread adoption of electronic health care records (EHRs) is essential to achieving many American health care goals, including improved care quality and patient safety”
The paper relies on this without support.
The benefits of well-managed EHRs are probably substantial.
“Although the benefits of well-managed EHRs may seem obvious and are likely substantial”
The paper relies on this without support.
Few EHR risk-management strategies have been published.
“Few EHR risk-management strategies have been published.”
The paper relies on this without support.
No published research identifies a comprehensive set of effective risk-reduction activities.
“In the absence of published research that identifies a comprehensive set of effective risk-reduction activities”
The paper relies on this without support.
Most EHR-related safety flaws are found and fixed before they cause a safety incident.
“Most of these flaws are identified and mitigated before a safety incident occurs.”
The paper relies on this without support.
A small fraction (anecdotally less than 0.1%) of flaws are discovered only after they contribute to an incident.
“A small number (anecdotally, Ͻ0.1%) are discovered after they contribute to an incident (for example, a medication administration error).”
The paper relies on this without support.
Smaller hospitals and most physician practices likely lack the resources to mount such an initiative.
“Smaller hospitals and most physician practices are unlikely to have the resources to mount such an initiative.”
The paper relies on this without support.
The decades-long iterative development of early EHRs improved the fit between the software and the organization, users, and care processes.
“The decades-long, iterative development process that these early EHRs went through improved the fit between the software and the organization, the users, and the care processes.”
The paper relies on this without support.
In the first organizations to use EHRs, software designers knew the organization, the users, and the care processes the EHR was meant to support.
“In the first organizations to use EHRs, software designers knew the organization, the EHR's users, and the specific care processes the EHR was meant to support.”
The paper relies on this without support.
Changing a complex EHR after development or implementation is extremely difficult, error-prone, and expensive.
“Changing a software system as complex as an EHR after it has been developed (or implemented) is enormously difficult, error-prone, and expensive.”
The paper relies on this without support.
Local EHR implementation and continuous-improvement teams make many decisions that can create system-safety flaws.
“Local EHR implementation and continuous-improvement teams make many decisions-regarding organizational policies, work processes, and software configurations-that have the potential to create system-safety flaws.”
The paper relies on this without support.
Some EHR flaws originate in the vendor's software creation process, while others come from the customer or from interactions between the EHR and other systems; the distinction is often hard to make.
“Some of these flaws will turn out to be related to the vendor's software creation process; others will have been introduced by the customer or by interactions between the EHR and other health care systems.Often, this distinction will be difficult to make.”
The paper relies on this without support.
A well-designed taxonomy of EHR-related system safety flaws and safety incidents has not yet been developed.
“The clearinghouse should be based on a well-designed taxonomy of EHR-related system safety flaws and safety incidents, which has yet to be developed.”
The paper relies on this without support.
Knowledge about how to develop, implement, and continuously improve EHRs for patient safety is currently limited and inaccessible to most health care organizations.
“Knowledge of how to develop, implement, and continuously improve EHRs for patient safety is currently limited and not accessible to most health care organizations.”
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?
Existing classifications, including AIMS and the ICPS, fall short with respect to computer-related incidents because this source of risk has not been systematically examined.
“However, existing classifications, including AIMS and the ICPS, 18 fall short with respect to computer-related incidents as this source of risk has yet to be systematically examined.20”
From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [20]
Incident reporting to facilitate rapid communication of safety flaws and critical events arising from computer use is one of seven steps proposed to improve the safety of healthcare IT.
“Indeed, incident reporting to facilitate rapid communication of safety flaws and critical events arising from computer use is one of seven steps which have been proposed to improve the safety of healthcare IT. 20”
From An analysis of computer-related patient safety incidents to inform the development of a classification (2010) · cites this paper as [20]
Cites
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations
GREENHALGH, T., ROBERT, G., MACFARLANE, F., BATE, P., & KYRIAKIDOU, O. (2004) · The Milbank Quarterly · doi:10.1111/j.0887-378x.2004.00325.x · Cited by 7,448 · see citing works
Wall, A. (2000) · British Journal of Healthcare Management · doi:10.12968/bjhc.2000.6.9.19311 · Cited by 5,909 · see citing works
A model for types and levels of human interaction with automation
Parasuraman, R., Sheridan, T. B., & Wickens, C. D. (2000) · IEEE Transactions on Systems, Man, and Cybernetics - Part A: Systems and Humans · doi:10.1109/3468.844354 · Cited by 4,195 · see citing works
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., & Shekelle, P. G. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-10-200605160-00125 · Cited by 3,159 · see citing works
Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., & Haynes, R. B. (2005) · JAMA · doi:10.1001/jama.293.10.1223 · Cited by 2,936 · see citing works
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 · see citing works
Bates, D. W. (1998) · JAMA · doi:10.1001/jama.280.15.1311 · Cited by 2,107 · see citing works
Handbook of Human-Computer Interaction
(1988) · Elsevier eBooks · doi:10.1016/c2009-0-12113-x · Cited by 2,057 · see citing works
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 · see citing works
Self-citationSafeware: System Safety and Computers
Leveson, N. G. (1995) · CERN Document Server (European Organization for Nuclear Research) · Cited by 1,660 · see citing works
Self-citationMaking health care safer: a critical analysis of patient safety practices.
Shojania, K. G., Duncan, B. W., McDonald, K. M., Wachter, R. M., & Markowitz, A. J. (2001) · PubMed Central · Cited by 1,612 · see citing works
The Impact of Computerized Physician Order Entry on Medication Error Prevention
Bates, D. W., Teich, J. M., Lee, J., Seger, D., Kuperman, G. J., Ma'Luf, N., Boyle, D., & Leape, L. (1999) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1999.00660313 · Cited by 1,260 · see citing works
Han, Y. Y., Carcillo, J. A., Venkataraman, S. T., Clark, R. S. B., Watson, R. S., Nguyen, T. C., Bayir, H., & Orr, R. A. (2005) · Pediatrics · doi:10.1542/peds.2005-1287 · Cited by 1,149 · see citing works
Types of Unintended Consequences Related to Computerized Provider Order Entry
Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2006) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2042 · Cited by 823 · see citing works
The Extent and Importance of Unintended Consequences Related to Computerized Provider Order Entry
Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K. P., Campbell, E., & Dykstra, R. H. (2007) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2373 · Cited by 500 · see citing works
Fortescue, E. B., Kaushal, R., Landrigan, C. P., McKenna, K. J., Clapp, M., Federico, F. A., Goldmann, D. A., & Bates, D. W. (2003) · PEDIATRICS · doi:10.1542/peds.111.4.722 · Cited by 462 · see citing works
Electronic Health Record Use and the Quality of Ambulatory Care in the United States
Linder, J. A., Ma, J., Bates, D. W., Middleton, B., & Stafford, R. S. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.13.1400 · Cited by 438 · see citing works
Beyond usability: Designing effective technology implementation systems to promote patient safety
Karsh, B.-T. (2004) · Quality and Safety in Health Care · doi:10.1136/qshc.2004.010322 · Cited by 414 · see citing works
Handbook of Human Factors and Ergonomics in Health Care and Patient Safety
Carayon, P. (2006) · CRC Press eBooks · doi:10.1201/9781482269505 · Cited by 412 · see citing works
Self-citationHigh Rates of Adverse Drug Events in a Highly Computerized Hospital
(2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.10.1111 · Cited by 363 · see citing works
Categorizing the unintended sociotechnical consequences of computerized provider order entry
Ash, J. S., Sittig, D. F., Dykstra, R. H., Guappone, K., Carpenter, J. D., & Seshadri, V. (2007) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2006.05.017 · Cited by 267 · see citing works
Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., Sam, J., & Haynes, R. B. (2007) · Cited by 253 · see citing works
Shulman, R., Singer, M., Goldstone, J., & Bellingan, G. (2005) · Critical Care · doi:10.1186/cc3793 · Cited by 252 · see citing works
A Consensus Statement on Considerations for a Successful CPOE Implementation
Ash, J. S. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1204 · Cited by 239 · see citing works
Computerized Physician Order Entry: Helpful or Harmful?
Berger, R. G. (2003) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m1411 · Cited by 223 · see citing works
Evaluation of Outpatient Computerized Physician Medication Order Entry Systems: A Systematic Review
Eslami, S., Abu-Hanna, A., & de Keizer, N. F. (2007) · Journal of the American Medical Informatics Association · doi:10.1197/jamia.m2238 · Cited by 200 · see citing works
Impact of emerging technologies on medication errors and adverse drug events
Oren, E., Shaffer, E. R., & Guglielmo, B. J. (2003) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/60.14.1447 · Cited by 190 · see citing works
Del Beccaro, M. A., Jeffries, H. E., Eisenberg, M. A., & Harry, E. D. (2006) · Pediatrics · doi:10.1542/peds.2006-0367 · Cited by 181 · see citing works
Computerization Can Create Safety Hazards: A Bar-Coding Near Miss
McDonald, C. J. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-7-200604040-00010 · Cited by 146 · see citing works
Smith, M. J., & Carayon, P. (1995) · International Journal of Human Factors in Manufacturing · doi:10.1002/hfm.4530050107 · Cited by 138 · see citing works
Self-citationA framework for analyzing the cognitive complexity of computer-assisted clinical ordering
Horsky, J., Kaufman, D. R., Oppenheim, M. I., & Patel, V. L. (2003) · Journal of Biomedical Informatics · doi:10.1016/s1532-0464(03)00062-5 · Cited by 137 · see citing works
Nolan, T. W. (1998) · Annals of Internal Medicine · doi:10.7326/0003-4819-128-4-199802150-00009 · Cited by 136 · see citing works
Sittig, D. F., Ash, J. S., Zhang, J., Osheroff, J. A., & Shabot, M. M. (2006) · Pediatrics · doi:10.1542/peds.2005-3132 · Cited by 130 · see citing works
Patient Safety Efforts Should Focus on Medical Errors
McNutt, R. A. (2002) · JAMA · doi:10.1001/jama.287.15.1997 · Cited by 123 · see citing works
Weiner, M., Gress, T., Thiemann, D. R., Jenckes, M. W., Reel, S., Mandell, S. F., & Bass, E. B. (1999) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1999.0060234 · Cited by 112 · see citing works
Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems
Miller, R. A., & Gardner, R. M. (1997) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.1997.0040442 · Cited by 101 · see citing works
Kilbridge, P. M. (2006) · Quality and Safety in Health Care · doi:10.1136/qshc.2005.014969 · Cited by 72 · see citing works
Changing perspectives on the organizational consequences of information technology
Eason, K. (2001) · Behaviour and Information Technology · doi:10.1080/01449290110083585 · Cited by 71 · see citing works
Summary Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems
Miller, R. A., & Gardner, R. M. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-9-199711010-00014 · Cited by 68 · see citing works
Sociotechnical issues in the implementation of imaging technology
Carayon, P., & Karsh, B.-T. (2000) · Behaviour & Information Technology · doi:10.1080/01449290050086363 · Cited by 65 · see citing works
Self-citationComputerized Provider Order Entry and Patient Safety
Lehmann, C. U., & Kim, G. R. (2006) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2006.09.006 · Cited by 45 · see citing works
Rosenbloom, S. T., Harrell, F. E., Lehmann, C. U., Schneider, J. H., Spooner, S. A., & Johnson, K. B. (2006) · Pediatrics · doi:10.1542/peds.2005-3163 · Cited by 38 · see citing works
Implementing an Electronic Health Record System
Walker, J. M., Richards, F., & Bieber, E. J. (2005) · Computers in health care · doi:10.1007/b138849 · Cited by 34 · see citing works
Self-citationUnderstanding the Organisational Ramifications of Implementing Information Technology Systems
Eason, K. (1997) · Elsevier eBooks · doi:10.1016/b978-044481862-1.50127-8 · Cited by 33 · see citing works
Kaushal, R., Shojania, K. G., & Bates, D. W. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.12.1409 · Cited by 30 · see citing works
Longhurst, C., Sharek, P. J., Hahn, J. S., Sullivan, J., & Classen, D. C. (2006) · PEDIATRICS · doi:10.1542/peds.2005-3048 · Cited by 17 · see citing works
Emergency Contraception: In Reply
Klein, J. (2006) · PEDIATRICS · doi:10.1542/peds.2005-2980 · Cited by 15 · see citing works
Sociotechnical System Design in Health Care
Carayon, P. (2006) · doi:10.1201/9781482269505-14 · Cited by 12 · see citing works
Self-citationAn Examination of Employee Participation during New Technology Implementation
Karsh, B. (1997) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/107118139704100209 · Cited by 9 · see citing works
Collaborative Initiatives for Patient Safety
Carayon, P. (2006) · doi:10.1201/9781482269505-19 · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
1 of the 52 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- 2006, Annals of Internal Medicine, 144, E-12
Cited by
Sorted by citations
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M., Payne, T. H., Rosenbloom, S. T., Weaver, C., & Zhang, J. (2013) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2012-001458 · Cited by 618 · see citing works
Health IT and Patient Safety: Building Safer Systems for Better Care
Chou, D. (2012) · JAMA · doi:10.1001/jama.308.21.2282-a · Cited by 496 · see citing works
(2013) · Europe PMC (PubMed Central) · Cited by 396 · see citing works
Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes
Bell, S. K., Delbanco, T., Elmore, J. G., Fitzgerald, P., Fossa, A. J., Harcourt, K., Leveille, S. G., Payne, T. H., Stametz, R. A., Walker, J., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.5867 · Cited by 242 · see citing works
Self-citationUsing FDA reports to inform a classification for health information technology safety problems
Magrabi, F., Ong, M.-S., Runciman, W., & Coiera, E. (2012) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000369 · Cited by 193 · see citing works
Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis
Shachak, A., Hadas-Dayagi, M., Ziv, A., & Reis, S. (2009) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0892-6 · Cited by 188 · see citing works
Singh, H., & Sittig, D. F. (2016) · BMJ Quality & Safety · doi:10.1136/bmjqs-2015-004486 · Cited by 167 · see citing works
Holden, R. J. (2010) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2009.12.003 · Cited by 162 · see citing works
Defining Health Information Technology–Related Errors
Sittig, D. F. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.327 · Cited by 167 · see citing works
Magrabi, F., Ong, M.-S., Runciman, W., & Coiera, E. (2010) · Journal of the American Medical Informatics Association · doi:10.1136/jamia.2009.002444 · Cited by 162 · see citing works
Holden, R. J. (2010) · Cognition Technology & Work · doi:10.1007/s10111-010-0141-8 · Cited by 134 · see citing works
Thomas Craig, K. J., Willis, V. C., Gruen, D., Rhee, K., & Jackson, G. P. (2021) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa301 · Cited by 123 · see citing works
ICU nurses' acceptance of electronic health records
Carayon, P., Cartmill, R. S., Blosky, M. A., Brown, R., Hackenberg, M., Hoonakker, P., Hundt, A. S., Norfolk, E. R., Wetterneck, T. B., & Walker, J. M. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2010-000018 · Cited by 118 · see citing works
Self-citationFactors contributing to an increase in duplicate medication order errors after CPOE implementation
Wetterneck, T. B., Walker, J. M., Blosky, M. A., Cartmill, R. S., Hoonakker, P., Johnson, M., Norfolk, E. R., & Carayon, P. (2011) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2011-000255 · Cited by 108 · see citing works
Self-citationMagrabi, F., Baker, M., Sinha, I., Ong, M.-S., Harrison, S., Kidd, M. R., Runciman, W. B., & Coiera, E. (2015) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2014.12.003 · Cited by 100 · see citing works
Horsky, J., McColgan, K., Pang, J. E., Melnikas, A., Linder, J. A., Schnipper, J. L., & Blackford Middleton, A. (2010) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2010.05.010 · Cited by 76 · see citing works
Safe Electronic Health Record Use Requires a Comprehensive Monitoring and Evaluation Framework
Sittig, D. F. (2010) · JAMA · doi:10.1001/jama.2010.61 · Cited by 76 · see citing works
A comparative review of patient safety initiatives for national health information technology
Magrabi, F., Aarts, J., Nøhr, C. G., Baker, M., Harrison, S., Sylvia Pelayo, A., Talmon, J. L., Sittig, D. F., & Coiera, E. W. (2012) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2012.11.014 · Cited by 74 · see citing works
Kushniruk, A. W., Bates, D. W., Bainbridge, M., Househ, M. S., & Borycki, E. M. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2012.12.006 · Cited by 74 · see citing works
Saleem, J. J., Russ, A. L., Sanderson, P., Johnson, T. R., Zhang, J., & Sittig, D. F. (2009) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638638 · Cited by 72 · see citing works
Sittig, D. F., Ash, J. S., & Singh, H. (2014) · PubMed · Cited by 72 · see citing works
Automated knowledge acquisition from clinical narrative reports.
Wang, X., Chused, A. E., Elhadad, N., Friedman, C., & Markatou, M. (2008) · PubMed Central · Cited by 68 · see citing works
Goekcimen, K., Schwendimann, R., Pfeiffer, Y., Mohr, G., Jaeger, C., & Mueller, S. M. (2022) · Journal of Patient Safety · doi:10.1097/pts.0000000000001072 · Cited by 81 · see citing works
Electronic Health Records and Improved Patient Care: Opportunities for Applied Psychology
Ratwani, R. M. (2017) · Current Directions in Psychological Science · doi:10.1177/0963721417700691 · Cited by 70 · see citing works
Mozaffar, H., Cresswell, K. M., Williams, R., Bates, D. W., & Sheikh, A. (2017) · BMJ Quality & Safety · doi:10.1136/bmjqs-2016-005879 · Cited by 60 · see citing works
Collins, S. A., & Vawdrey, D. K. (2012) · Applied Nursing Research · doi:10.1016/j.apnr.2011.06.002 · Cited by 50 · see citing works
Martin, G., Ghafur, S., Cingolani, I., Symons, J., King, D., Arora, S., & Darzi, A. W. (2019) · The Lancet Digital Health · doi:10.1016/s2589-7500(19)30057-3 · Cited by 49 · see citing works
Screening Electronic Health Record–Related Patient Safety Reports Using Machine Learning
Marella, W. M., Sparnon, E., & Finley, E. (2014) · Journal of Patient Safety · doi:10.1097/pts.0000000000000104 · Cited by 50 · see citing works
Bowles, K. H., Adelsberger, M. C., Chittams, J. L., Liao, C., & SOCKOLOW, P. S. (2014) · Applied Clinical Informatics · doi:10.4338/aci-2013-12-ra-0106 · Cited by 45 · see citing works
Magrabi, F., Ong, M.-S., Runciman, W. B., & Coiera, E. W. (2011) · PubMed Central · Cited by 48 · see citing works
EHR‐related medication errors in two ICUs
Carayon, P., Du, S., Brown, R., Cartmill, R. S., Johnson, M., & Wetterneck, T. B. (2017) · Journal of Healthcare Risk Management · doi:10.1002/jhrm.21259 · Cited by 43 · see citing works
Self-citationRuss, A. L., Saleem, J. J., Justice, C. F., Woodward-Hagg, H., Woodbridge, P. A., & Doebbeling, B. N. (2010) · Health Informatics Journal · doi:10.1177/1460458210365981 · Cited by 41 · see citing works
Creating an Oversight Infrastructure for Electronic Health Record–Related Patient Safety Hazards
Singh, H., Classen, D. C., & Sittig, D. F. (2011) · Journal of Patient Safety · doi:10.1097/pts.0b013e31823d8df0 · Cited by 45 · see citing works
Understanding e-government research
Muñoz, L. A., & Bolívar, M. P. R. (2015) · Internet Research · doi:10.1108/intr-12-2013-0259 · Cited by 40 · see citing works
Impact of Heath Information Technology on the Quality of Patient Care.
Hessels, A., Flynn, L. T., Cimiotti, J. P., Henry, S. B., & Gershon, R. (2015) · PubMed · Cited by 33 · see citing works
Jeskey, M., Card, E., Nelson, D., Mercaldo, N. D., Sanders, N. W., Higgins, M. S., Shi, Y., Michaels, D. R., & Miller, A. (2011) · Journal of Nursing Management · doi:10.1111/j.1365-2834.2011.01295.x · Cited by 31 · see citing works
Effects of Electronic Health Information Technology Implementation on Nursing Home Resident Outcomes
Pillemer, K. A., Meador, R., Teresi, J. A., Chen, E. K., Henderson, C., Lachs, M. S., Boratgis, G. D., Silver, S. A., & Eimicke, J. P. (2011) · Journal of Aging and Health · doi:10.1177/0898264311408899 · Cited by 31 · see citing works
Comparing usability testing outcomes and functions of six electronic nursing record systems
Cho, I., Kim, E., Choi, W. H., & Staggers, N. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.01.007 · Cited by 31 · see citing works
Borycki, E. M., Carayon, P., Jaspers, M., Sylvia Pelayo, A., & Beuscart-Zéphir, M.-C. (2013) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638835 · Cited by 30 · see citing works
Self-citationHealth Information Technologies: Which Nursing Homes Adopted Them?
Zhang, N., Lu, S. F., Xu, B., Wu, B., Rodríguez-Monguió, R., & Gurwitz, J. H. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.02.028 · Cited by 28 · see citing works
Sepehri, K., Holsti, L., Niasati, S., Chan, V., & MacLean, K. E. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581459 · Cited by 27 · see citing works
Rights and responsibilities of users of electronic health records
Sittig, D. F., & Singh, H. (2012) · Canadian Medical Association Journal · doi:10.1503/cmaj.111599 · Cited by 28 · see citing works
Effect of an electronic medication administration record application on patient safety
Oliveros, N. V., Gramage, T., Menéndez-Conde, C. P., et al. (2017) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12753 · Cited by 27 · see citing works
Resilient practices in maintaining safety of health information technologies
Smith, M. W., Ash, J. S., Sittig, D. F., & Singh, H. (2014) · Journal of Cognitive Engineering and Decision Making · doi:10.1177/1555343414534242 · Cited by 26 · see citing works
Decision Support and Patient Safety
Plebani, M., Aita, A., Padoan, A., et al. (2019) · Clinics in Laboratory Medicine · doi:10.1016/j.cll.2019.01.003 · Cited by 26 · see citing works
The Effects of Information Technology on Perioperative Nursing
Sweeney, P. (2010) · AORN Journal · doi:10.1016/j.aorn.2010.02.016 · Cited by 25 · see citing works
Martin, P. M., & Sbaffi, L. (2019) · Health Informatics Journal · doi:10.1177/1460458219895184 · Cited by 24 · see citing works
Meaningful Use and Certification of Health Information Technology: What about Safety?
Hoffman, S., & Podgurski, A. (2011) · The Journal of Law Medicine & Ethics · doi:10.1111/j.1748-720x.2011.00572.x · Cited by 21 · see citing works
Horsky, J., & Ramelson, H. Z. (2016) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2016.10.004 · Cited by 21 · see citing works
HIPAA Privacy Rule compliance: An interpretive study using Norman’s action theory
Liginlal, D., Sim, I., Khansa, L., & Fearn, P. (2011) · Computers & Security · doi:10.1016/j.cose.2011.12.002 · Cited by 18 · see citing works
Development of Mobile Electronic Health Records Application in a Secondary General Hospital in Korea
Choi, W., Park, M. A., Hong, E. S., et al. (2013) · Healthcare Informatics Research · doi:10.4258/hir.2013.19.4.307 · Cited by 20 · see citing works
Pitts, S. I., Barasch, N., Maslen, A., Thomas, B. A., Dorissaint, L. P., Decker, K. G., Kazi, S., Yang, Y., & Chen, A. R. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1688698 · Cited by 17 · see citing works
Thayer, J. G., Miller, J. M., Fiks, A. G., Tague, L., & Grundmeier, R. W. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1683985 · Cited by 14 · see citing works
Health IT for Patient Safety and Improving the Safety of Health IT
Magrabi, F., Mei-Sing, O., & Coiera, E. W. (2016) · Studies in health technology and informatics · doi:10.3233/978-1-61499-635-4-25 · Cited by 14 · see citing works
Lau, A. Y. S., Tsafnat, G., Sintchenko, V., Magrabi, F., & Coiera, E. W. (2009) · Yearbook of Medical Informatics · doi:10.1055/s-0038-1638644 · Cited by 14 · see citing works
Kargul, G. J., Wright, S. M., Knight, A. M., McNichol, M., & RIGGIO, J. M. (2012) · American Journal of Medical Quality · doi:10.1177/1062860612445307 · Cited by 13 · see citing works
Pfeiffer, Y., Zimmermann, C., & Schwappach, D. L. B. (2020) · Journal of Patient Safety · doi:10.1097/pts.0000000000000640 · Cited by 12 · see citing works
Moving towards efficient, safe, and meaningful healthcare: issues for automation
Falan, S., & Han, B. T. (2011) · International Journal of Electronic Healthcare · doi:10.1504/ijeh.2011.039060 · Cited by 11 · see citing works
Kennedy, B. P., Kerns, E. K., Chan, Y., Chaparro, B. S., & Fouquet, S. D. (2019) · Applied Clinical Informatics · doi:10.1055/s-0039-1681073 · Cited by 9 · see citing works
Liu, T., Liang, L., Che, C., Liu, Y., & Jin, B. (2025) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2025.104826 · Cited by 10 · see citing works
Inter-structure and intra-semantics graph contrastive learning for disease prediction
Kang, Y., Zheng, J., Yang, M., & An, N. (2024) · Knowledge-Based Systems · doi:10.1016/j.knosys.2024.112059 · Cited by 9 · see citing works
Sujan, M. A. (2018) · BMJ Health & Care Informatics · doi:10.14236/jhi.v25i1.952 · Cited by 8 · see citing works
Wang, T., Wang, Y., & Moczygemba, J. (2014) · The Health Care Manager · doi:10.1097/01.hcm.0000440624.85255.8e · Cited by 8 · see citing works
(2010) · doi:10.1056/nejmc1010028 · Cited by 8 · see citing works
Decision support and patient safety: the time has come
Hasley, S. K. (2011) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2010.10.901 · Cited by 7 · see citing works
A continuous usability evaluation of an electronic medication administration record application
Oliveros, N. V., Gramage, T., Menéndez-Conde, C. P., Álvarez‐Díaz, A. M., Martín‐Aragón, S., Vicedo, T. B., & Silveira, E. D. (2017) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12808 · Cited by 7 · see citing works
Yuan, M., Powell, G. A., Lavigne, M., et al. (2017) · PubMed · Cited by 7 · see citing works
Pruitt, Z. M., Howe, J. L., Bocknek, L. S., Milicia, A. P., Spaar, P. A., Krevat, S. A., & Ratwani, R. M. (2023) · Patient Safety · doi:10.33940/001c.77769 · Cited by 6 · see citing works
Defining Health Information Technology-Related Errors
Singh, H. (2013) · Apple Academic Press eBooks · doi:10.1201/b16306-6 · Cited by 6 · see citing works
Miller, A., Pilcher, D. V., Mercaldo, N. D., Leong, T., Scheinkestel, C. D., & Schildcrout, J. S. (2010) · Australian Critical Care · doi:10.1016/j.aucc.2010.02.001 · Cited by 5 · see citing works
Ergonomics in Healthcare and Patient Safety
(2014) · Journal of Ergonomics · doi:10.4172/2165-7556.1000e126 · Cited by 5 · see citing works
Taylor, L., Wood, S. D., & Chapman, R. J. (2012) · doi:10.1518/hcs-2012.945289401.001 · Cited by 5 · see citing works
Integration of multiple health information systems for quality improvement of radiologic care
Wang, K., Zwart, C. M., Wellnitz, C. V., et al. (2017) · IISE Transactions on Healthcare Systems Engineering · doi:10.1080/24725579.2017.1329241 · Cited by 5 · see citing works
Varying rates of patient identity verification when using computerized provider order entry
Fortman, E., Hettinger, A. Z., Howe, J. L., Fong, A., Pruitt, Z. M., Miller, K. M., & Ratwani, R. M. (2020) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocaa047 · Cited by 5 · see citing works
Healthcare Workers' Perceptions of Information in the Electronic Health Record
Russ, A. L., Saleem, J. J., Justice, C. F., Woodward-Hagg, H., Woodbridge, P. A., & Doebbeling, B. N. (2009) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/154193120905301101 · Cited by 5 · see citing works
AlHussainan, A., & Alhuwail, D. (2025) · JMIR Medical Informatics · doi:10.2196/70782 · Cited by 4 · see citing works
Privacy Issues with the Electronic Medical Record
Aselton, P., & Affenito, S. G. (2014) · ScholarWorks@UMassAmherst (University of Massachusetts Amherst) · Cited by 4 · see citing works
Integrating People, Process, and Technology in Lean Healthcare.
Husby, B. (2012) · Deep Blue (University of Michigan) · Cited by 4 · see citing works
Altabbaa, G., Flemons, W. W., Ocampo, W., et al. (2024) · BMJ Open Quality · doi:10.1136/bmjoq-2023-002574 · Cited by 3 · see citing works
Evidence-based validation and improvement of electronic health record systems
Podgurski, A. (2010) · FSE/SDP Workshop on Future of Software Engineering Research (FoSER) · doi:10.1145/1882362.1882422 · Cited by 3 · see citing works
Sittig, D. F., Longhurst, C., Russo, E. M., & Singh, H. (2015) · Health informatics · doi:10.1007/978-3-319-20765-0_2 · Cited by 3 · see citing works
Interfacing and integrating digital technologies in the electronic health record
Egarhos, N. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-824010-6.00077-0 · Cited by 4 · see citing works
Heath, M. L., & Appan, R. (2014) · Journal of the Association for Information Systems · Cited by 3 · see citing works
Securing e-Healthcare Information
Shoniregun, C. A., Dube, K., & Mtenzi, F. J. (2010) · Advances in information security · doi:10.1007/978-0-387-84919-5_2 · Cited by 3 · see citing works
Efectividad de la evaluación de historias clínicas informatizadas en un hospital universitario
González, A. C., Durán, X. P., & Lozano-Rubí, R. (2017) · Revista de Calidad Asistencial · doi:10.1016/j.cali.2017.09.004 · Cited by 3 · see citing works
Malfunction Transparency in Clinical Decision Support Systems: A Classification Approach
Jones, R. W., Mateer, J. E., & Harrison, M. J. (2019) · IEEE Conference on Industrial Electronics and Applications (ICIEA) · doi:10.1109/iciea.2019.8834049 · Cited by 3 · see citing works
Beyond Electronic Health Record Adoption
Krawiec, C. (2019) · Methods of Information in Medicine · doi:10.1055/s-0040-1709148 · Cited by 2 · see citing works
Sutton, R. T., Dhillon-Chattha, P., Kumagai, J. K., et al. (2023) · Applied Clinical Informatics · doi:10.1055/s-0043-1771392 · Cited by 2 · see citing works
Alomair, R. A., & Pasha, S. A. (2024) · Open Access Public Health and Health Administration Review · doi:10.59644/oaphhar.2(2).97 · Cited by 2 · see citing works
Bozan, K., & Datta, P. M. (2016) · Healthcare delivery in the information age · doi:10.1007/978-3-319-25973-4_7 · Cited by 2 · see citing works
Impact of health information technology on delivery and quality of patient care
Hessels, A. (2014) · 42nd Biennial Convention (16 November - 20 November 2013) · doi:10.7282/t3f769t9 · Cited by 1 · see citing works
An Overview of HIT-Related Errors
Magrabi, F., Ong, M., & Coiera, E. W. (2016) · Springer eBooks · doi:10.1007/978-3-319-31123-4_2 · Cited by 2 · see citing works
Bozan, K. (2014) · OhioLink ETD Center (Ohio Library and Information Network) · Cited by 1 · see citing works
CancelRx case study: implications for clinic and community pharmacy work systems
Watterson, T. L., Stone, J. A., Kleinschmidt, P. C., & Chui, M. A. (2023) · BMC Health Services Research · doi:10.21203/rs.3.rs-2859918/v1 · Cited by 2 · see citing works
Quality, Safety, and the Electronic Medical Record
Smith, C. T., & Jackson, G. P. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7901-8_5 · Cited by 1 · see citing works
Avoiding Adverse Consequences of E-Health
O’Hanlon, S. (2012) · IGI Global eBooks · doi:10.4018/978-1-4666-2657-7.ch002 · Cited by 1 · see citing works
Health Information Technologies: Which Nursing Homes Adopted Them?Preprint
Zhang, N., Lu, S. F., Xu, B., et al. (2016) · SSRN Electronic Journal · doi:10.2139/ssrn.2737195 · Cited by 1 · see citing works
Biomedical Data, Knowledge, and Systems in Context
Kalet, I. J. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-416019-4.00006-8
- Authors
- Walker, J. M., Carayon, P., Leveson, N., Paulus, R. A., Tooker, J., Chin, H., Bothe, A., & Stewart, W. F.
- Affiliations
- Geisinger Health System (US)
- University of Wisconsin System (US)
- Massachusetts Institute of Technology (US)
- American College of Physicians (US)
- Kaiser Permanente (US)
- Geisinger Medical Center (US)
- Corresponding author
- Walker, J. M.
- Venue
- Journal of the American Medical Informatics Association
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-05-01
- Volume
- 15
- Issue
- 3
- Pages
- 272-277
- ISSN
- 1067-5027 (ISSN-L)
- 1527-974X
- PMC
- PMC2409999
- OpenAlex
- W30038292
- Semantic Scholar
- e79e16206458fd09a10c7cd9fb2a73a9d5dfa8f9
- Cited by
- 113
- References
- 52
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 10 · 2018: 1 · 2017: 8 · 2016: 6 · 2015: 8 · 2014: 11 · 2013: 8 · 2012: 7
- FWCI
- 24.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Medical Informatics Association (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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, EHR design, EHR implementation, healthcare process improvement, human factors engineering, software safety, safety testing, safety reporting, incident communication, small hospitals, physician practice, quality of care
- MeSH terms
- Humans, Safety, Software, Medical Records Systems, Computerized, Medical Errors
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.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-07.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-07.
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 ›
Are you an author, or do you see a problem with this page? Request a review
