Cited by 113Electronic Health Records SystemsPatient Safety and Medication ErrorsMedical Coding and Health Information

The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index; none of the 48 sources its claims cite is checked for support yet.

EHR Safety: The Way Forward to Safe and Effective Systems

Open access
Walker, J. M., Carayon, P., Leveson, N., Paulus, R. A., Tooker, J., Chin, H., Bothe, A., Stewart, W. F.·2008·Journal of the American Medical Informatics Association

Abstract

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.

Overview

Integrity signals

Registry

Crossref · 10.1197/jamia.m2618

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

23 Not checked yet · 2 Own interpretation · 1 No basis given

Verify all 48 references — free account
  • It may state two separate claims as one. 6
  • Probably not a substantial claim. 2
7 of 7
  • 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.”
14 of 14

Claims other papers make about this one

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Citations

Cites

Show all 52 references

Research works printed but not linked: 1

  1. 2006, Annals of Internal Medicine, 144, E-12

Cited by

Sorted by citations

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Metadata

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
Published
2008-05-01
Volume
15
Issue
3
Pages
272-277
ISSN
  • 1067-5027 (ISSN-L)
  • 1527-974X
OpenAlex
W30038292
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
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 › 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, 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

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