Philadelphia, PA: Pew Charitable Trusts; July 21, 2020.
Tracking problems with health information technology (Health IT) is an important strategy to drive improvement. This report outlines general health IT and decision support actions to inform action, and discusses the role that regulation and accreditation have for driving improvement.
Classen DC, Holmgren AJ, Co Z, et al. JAMA Netw Open. 2020;3.
Researchers measured the safety performance of electronic health record (EHR) systems using simulated medication orders that can lead to adverse events or death in order to evaluate how well the systems identified these errors, and the mitigating effect of computerized physician order entry and clinical decision support (CDS) tools. Safety performance increased moderately over the 10-year study period but there was considerable variation in performance based on the level of decision support (basic or more complex) and EHR vendor; safety risks persist despite EHR implementation.
Health care is working to provide high-value care and prevent overuse while ensuring patient safety. This commentary highlights the importance of educational initiatives, mentors, and use of clinical decision support to help clinicians determine what amount of care is appropriate for a given clinical situation.
He J, Baxter SL, Xu J, et al. Nat Med. 2019;25:30-36.
Artificial intelligence (AI) is seen as a transformative technology for data application, decision making, and research. This commentary summarizes issues surrounding widespread use of AI in health care, such as integration into clinical workflow, data standardization, and patient safety.
Jha AK, DesRoches CM, Campbell EG, et al. N Engl J Med. 2009;360:1628-38.
Increasing the use of electronic health records (EHRs) is a major policy priority, as implementation has been slow both in the United States and in other countries. This survey of nearly 3000 US hospitals found that less than 2% had a fully functional EHR (defined as incorporating clinical documentation, laboratory and imaging results, computerized provider order entry, and clinician decision support). Survey respondents cited cost and maintenance considerations as major barriers to adopting EHRs, concerns that have been cited in prior research. Given that most outpatient practices also do not use electronic records, the authors recommend several policy initiatives to spur EHR implementation.
A woman with symptoms of sinusitis was given 2 different courses of broad-spectrum antibiotics, neither of which improved her symptoms. Hospitalized for autoimmune hemolysis (presumably from the antibiotic), the patient suffered multiorgan failure and septic shock, and died.
Subramanian S, Hoover S, Gilman BH, et al. J Am Geriatr Soc. 2007;55:1451-1457.
In analyzing barriers that prevent broad use of computerized physician order entry (CPOE) in long-term care facilities, this review details how misalignment between stakeholder costs and benefits could stall adoption.
Simon JS, Rundall TG, Shortell SM. J Am Med Inform Assoc. 2007;14:432-9.
The authors surveyed primary care medical groups and found that only 27% have electronic order entry with decision support for chronic disease care. External quality incentives were associated with driving adoption of such tools.
Avery AJ, Savelyich BSP, Sheikh A, et al. Qual Saf Health Care. 2007;16:28-33.
Enhanced information technology (IT) has been identified as a key component of improving patient safety, but development and implementation of health care IT systems have sometimes led to unintended consequences. In this study, the authors interviewed 31 health care IT stakeholders, ranging from IT developers to frontline clinicians, to identify priority areas for improving IT in the primary care setting. Interviewees voiced a strong interest in using IT for decision support but were frustrated with a perceived lack of attention to human factors engineering in current IT systems.
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